University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

119

Pages:

3
Author:

Mariam A. A.

Thyroid Examination Component • Wash hands • Introduce self. • Briefly explain purpose and obtain consent. • Ask about pain before you begin. • Ask for vitals. • Weight. General Inspection What to do/look for and rationale • • • • • Hands • • • • Step back and perform a survey: - Look for syndromes. - Attachments - Mobility aids - Lines. - Mental status. Obvious swellings. Clothing - Loose -> hyperthyroidism. - Tight -> hypothyroidism. Hoarse voice -> compression of the larynx due to thyroid gland enlargement. Behaviour: - Hyperactive, anxious etc. -> hyperthyroidism. - Low mood -> hypothyroidism. Thyroid acropathy: - Autoimmune antibodies simulate GAGs and adipose -> Grave’s. Palmar erythema: - Hyperthyroidism -> due to an increase in cutaneous blood flow. - Pregnancy. - Chronic liver failure. Onycholysis: - Painless detachment of the nail from the nail bed. Radial pulse - If increased -> hyperthyroidism. • Face • • • • • • • Neck • • • - If decreased -> hypothyroidism. Peripheral tremor: - Hyperactive SNS -> hyperthyroidism. Sweating -> hyperthyroidism. Dry skin -> hypothyroidism. Loss of eyebrows -> hypothyroidism. - Because there is a reduced reduction of hair follicles and the low T4 will cause a decrease in the duration of the hair growth phase. Lid retraction - Inspect from the front to note if the sclera is visible between the upper lid margin and the corneal limbus -> indicates lid retraction. Exophthalmos - Grave’s because there are antibodies attacking the pre-orbital space and stimulate fibroblasts to make GAGs and adipose. Eye movements - Do a H shape and ask if there are any double vision -> grave’s disease. Lid lag - Delay in the descent of the upper eyelid in relation to the eyeball when looking downwards -> Grave’s disease. - Hold your finger supervisor and ask the patient to follow with their eyes whilst keeping their head still. Inspect the midline for evidence of thyroid enlargement, lumps and scars. Palpate from behind the neck and ask about tenderness. - Ask patient to tilt their chin. - Locate Adam’s apple. - Move fingers inferiorly until you reach the cricoid cartilage. - Note character and number of nodules if present. Repeat while asking the patient to take a slip of water to assess the lower boarder. - Tongue Protrusions • • Percussion of the sternum • Auscultation • • Specialty tests • • • Allows the shape of the gland to be better seen and causes the thyroid to rise up by 2 cm. - Thyroglossal cysts usually move upwards with swallowing. - Lymph nodes do not move much with swallowing. - An invasive thyroid malignancy may not move with swallowing if tethered to the surrounding tissue. Palpate cervical nodes. Ask patient to protrude tongue out. - If moves up -> thyroglossal cysts. - Masses and lymph nodes will not move. Percuss from sternal notch for evidence of retrosternal dullness. - If present may indicate large thyroid mass. Do it for each lobe. If a bruit is there this means that there is an increased blood flow which means, there is hyperthyroidism. Biceps reflex - Hyperreflexia -> hyperthyroidism. - Hyporeflexia -> hypothyroidism. Pretibial myxoedema - GAGS’s accumulation -> rare complication of Grave’s. Proximal myopathy - Hyperthyroidism.