ENDOCRINE EXAMINATION: THYROID

Wimpie de LangeDiv. of Endocrinology

Dept. of Internal Medicine

April 21, 2023

ENDOCRINE EXAMINATIONThe Thyroid

INSPECTION

The isthmus of the thyroid can be visible in a very thin patient.

Swallow Swallow water: Thyroid moves

Scars (thyroidectomy)

Dilated neck veins

Redness

Lymph nodes

Stick out tongue

PALPATION

Size

Form/ consistency

Tenderness

Mobility

Repeat when patient swallows water

Cervical lymph nodes and carotid arteries

[Site/ Size/ Shape/ Colour/ Contour/ Consist./ Temp./ Tender/ Nodes/ ]

PERCUSSION AND AUSCULTATION

Percuss for a retrosternal thyroid.Auscultate for a bruit.

Pemberton’s sign: Pemberton’s sign: patient lifts his/her arms above the head:

Cyanosis/ congestion of the faceRespiratory distress/ stridorEngorgement of neck veinsSyncope

SIGNS OF HYPERTHYROIDISM

Signs of weight lossAnxietyHands: Fine tremors, onycholysis (Plummer’s nails), thyroid acropachythyroid acropachy, palmar erythema, skin warm and clammy.Pulse: Sinus tachycardia, atrial fibrillation, hyperdynamic circulation.Chest: Heart murmur22, heart failureLegs: Pre-tibial myxoedemaPre-tibial myxoedema, Proximal muscle weakness and increased reflexes.

EYE SIGNS

Sympathetic overactivity: staring gaze, lid retraction, lid lagPtosisExophthalmos ChemosisConjunctivitisCorneal ulcerationOptic atrophyOphthalmoplegia

HYPOTHYROIDISM

Signs of general lethargia

Hands: peripheral cyanosis, swelling of the skin, skin feels cool and dry, anaemia, hypercarotenaemia, Tinel’s sign (carpal tunnel syndrome)

Pulse: slow, small volume

Proximal muscle weakness and decreased (slow) reflexes.

Face: Skin thickened, alopecia, vitiligo, periorbital oedema, Quenn Anne sign, xanthelasma, hair dry, skin coarse, nerve deafness.

Chest: pleural and pericardial effusion.