Examination of Thyroid Gland
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Examination of Thyroid Gland Inspection Palpation Percussion Auscultation Sitting Position with Neck Extending Exposure – Top of Head → Mid Chest Semiflexed Position (Relax Sternomastoid) Upper Part of Manubrium (Retrosternal Goitre) Each Lobe (at Upper Pole) Bruit Sign of ↑ Blood Supply (Hyperthyroidism) (Occasionally use of Antithyroid Drugs) 1. Site In front of Neck Extending from 1 Steromastoid to other Vertically (Suprasternal Notch → Thyroid Cartilage) Both hands placed with Pulp of Fingers over the Gland Feels systematically both lobes Differentiate from Carotid Bruit 2. Size 3. Shape 4. Movement with Swallowing 5. Surface Smooth Irregular Nodular 1. Temperature Pemberton’s Sign Lift both arms as high as possible (few moments) Sign of • Facial Congestion (Plethora) • Cyanosis • Respiratory Distress • Non-Pulsatile Elevation of JVP • Stridor (during Taking Deep Breath through Mouth) Adenoma Carcinoma MNG 2. Tenderness Puberty Goitre 3. Site 4. Size Grav e’s 5. Shape 6. Lower Border (Ask patient to Swallow) 6. Surface 7. Consistency 7. Skin Dilated Veins Infiltration of Skin Scar Soft Firm Hard Grav e’s Adenoma Carcinoma Exam Exopthalmos Naffziger’s Method Detect Exophthalmos Marked Exophthalmos Colloid Goitre MNG Calcification of MNG 8. Swelling moves with Deglutition Due to Ligament of Berry If Restriction • Malignancy • Retrosternal Goitre • Large Goitre • Previous Surgery 8. Thrill 9. Lower Edge Confirm movement with swallowing Feel Lower Edge 10. Surrounding Structure Skin – Sliding, Push & Pinch, Swelling under skin Sternomastoid – Pinch Sternomastoid from swelling during swallowing Trachea – Fixed or not, Displaced Carotid Pulse – Displaced, Berry’s Sign Other Swelling – Lymph Nodes 9. Movement on Protrusion of Tongue Thyroglossal Cyst Lid Retraction Stellwag’s Sign Unilateral Lid Retraction Mocbius Sign Difficult Convergence Joffroy’s Sign No Wrinkles 10. Surrounding Structure Get Smaller on Sternomastoid Contraction 11. Other Swelling Lymph Nodes 11. Movement with Swallowing Pizillo’s Method (Obese, Short Neck) Patient throw Head Backwards Press occiput against clasped hand 12. Ask Patient to Talk Exclude Hoarseness of Voice Chemosis Severe Chemosis Lahey’s Method Push Gland to 1 side while examining the other lobe Crile’s Method (for Small Gland) Thumb placed over Lobe while patient Swallowing Other Examination Chest Abdomen Upper Limb Lower Limb Tenderness over the Ribs Liver Metastases CHF Hand Warm Sweaty Hyperthyroidism Hypothyroidism Chest Lung Metastases Consolidation Pleural Effusion Hyperreflexia Hyporeflexia Pretibial Myxedema Splenomegaly Thyroid Lymphoma Grave’s Disease Hashimoto Disease Fine Tremors Water Hammer (Collapsing) Pulse CVS Tachycardia Murmurs Hypothyroidism Dark Skin Pale Skin Back Vertebral Metastases Malignant Ascites
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Examination of Thyroid Gland
Transcript of Examination of Thyroid Gland
Examination of Thyroid Gland
Inspection Palpation Percussion Auscultation
Sitting Position with Neck Extending
Exposure – Top of Head → Mid Chest
Semiflexed Position
(Relax Sternomastoid)
Upper Part of Manubrium
(Retrosternal Goitre)
Each Lobe (at Upper Pole)
Bruit
Sign of ↑ Blood Supply
(Hyperthyroidism)
(Occasi onally use of Antithyroid Drugs)
1. Site
In front of Neck
Extending from 1 Steromastoid to other
Vertically
(Suprasternal Notch → Thyroid Cartilage)
Both hands placed with
Pulp of Fingers over the Gland
Feels systematically both lobes
Differentiate from Carotid Bruit
2. Size
3. Shape
4. Movement with Swallowing
5. Surface
Smooth Irregular Nodular 1. Temperature Pemberton’s Sign
Lift both arms as high as possible (few moments )
Sign of
• Facial Congestion (Plethora)
• Cyanosis
• Respiratory Distress
• Non-Pulsatile Elevation of JVP
• Stridor (during Taking Deep Breath through Mouth)
Adenoma Carcinoma MNG 2. Tenderness
Puberty
Goitre
3. Site
4. Size
Grav e’s 5. Shape
6. Lower Border
(Ask patient to Swallow)
6. Surface
7. Consistency
7. Skin
Dilated Veins
Infiltration of Skin
Scar
Soft Firm Hard
Grav e’s Adenoma Carcinoma Exam Exopthalmos
Naffziger’s Method
Detect Exophthalmos
Marked Exophthalmos
Colloid
Goitre
MNG Calcification
of MNG
8. Swelling moves with Deglutition
Due to Ligament of Berry
If Restriction
• Malignancy
• Retrosternal Goitre
• Large Goitre
• Previous Surgery
8. Thrill
9. Lower Edge
Confirm movement with swallowing
Feel Lower Edge
10. Surrounding Structure
Skin – Sliding, Push & Pinch, Swelling
under skin
Sternomastoid – Pinch Sternomastoid
from swelling during swallowing
Trachea – Fixed or not, Displaced
Carotid Pulse – Displaced, Berry’s Sign
Other Swelling – Lymph Nodes
9. Movement on Protrusion of Tongue
Thyroglossal Cyst Lid Retraction
Stellwag’s Sign
Unilateral Lid Retraction
Mocbius Sign
Difficult Convergence
Joffroy’s Sign
No Wrinkles
10. Surrounding Structure
Get Smaller on
Sternomastoid Contraction
11. Other Swelling
Lymph Nodes
11. Movement with Swallowing
Pizillo’s Method
(Obese, Short Neck)
Patient throw Head Backwards
Press occiput against clasped hand
12. Ask Patient to Talk
Exclude Hoarseness of Voice
Chemosis
Severe Chemosis
Lahey’s Method
Push Gland to 1 side while
examining the other lobe
Crile’s Method
(for Small Gland)
Thumb placed over Lobe while
patient Swallowing
Other Examination
Chest Abdomen Upper Limb Lower Limb
Tenderness over the Ribs Liver
Metastases
CHF
Hand
Warm
Sweaty
Hyperthyroidism Hypothyroidism
Chest
Lung Metastases
Consolidation
Pleural Effusion
Hyperreflexia Hyporeflexia
Pretibial
Myxedema
Splenomegaly
Thyroid Lymphoma
Grave’s Disease
Hashimoto Disease
Fine Tremors
Water Hammer (Collapsing) Pulse
CVS
Tachycardia
Murmurs
Hypothyroidism
Dark Skin
Pale Skin Back
Vertebral Metastases
Malignant Ascites
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