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Thyroid Examination
Wail Alamoudi
•General examination
•Local examination
Local examination• Inspection• ( at rest , tongue , swallowing , raising both hands )
• Palpation• Percussion• Auscultation
•Tip the patients head back a bit•Inspect thyroid gland & scar•A visibly enlarged thyroid gland is called a goiter. •Note whether it is visible and symmetrical
Inspection at rest
Is This a Thyroid?
• Ask patient to stick tongue out while palpating:
• Ask patient to swallow water:
Should NOT move
Should move
Thyroglossal cyst
Inspection while raising hands
1. pemberton's sign ( retrosternal goiter )
development of facial flushing, distended neck and head superficial veins, inspiratory strider and elevation of the jugular venous pressure (JVP) upon raising of the patient's both arms above head
2. Proximal myopathy
ANATOMIC BONDARIES OF THYROID
• Cricoid cartilage• Suprasternal notch• Carotid arteries
palpation
ANATOMIC RELATIONSHIPS OF THE THYROID
Palpation
Palpation
• Palpate the thyroid gland from behind• Localize anatomic boundaries• Thyroid isthmus is often palpable• Thyroid lobes are barely or not palpable• The consistence is rubbery, similar to that of
sternomastoid muscle
Classical Clinical Examination
The following information could be obtainedývolume ýconsistencyýmobility of the thyroid glandýsurfaceýtemperatureýsensibility
Percussion
On the upper part of the manubrium looking for retrosternal goiter
Auscultation
Looking for bruit over each thyroid lobe
•General examination
•Local examination
General inspection
• body built• Eyes & Face• Hands• Arms & Legs
body built
• Thin • Obese
Face
1. malar flush2. Hair loss
1. Exophthalmos2. Lid retraction3. Lid lag4. Xanthelasma
Eyes
Hands
1. Sweaty hand2. Temperature3. Acropachy (clubbing)4. Onycholysis( plummer’s nails )5. Palmer erythema6. vitiligo7. Tremor 8. Pulse
Legs and Arms
• Proximal myopathy• Reflexes• Pretibial myxedema
Wail Alamoudi
0504649662
• Identify the cricoid cartilage with the fingers of both hands.
• Move downward two or three tracheal rings while palpating for the isthmus.
• Move laterally from the midline while palpating for the lobes of the thyroid.
• Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. The normal gland is often not palpable.
