Thyroid exam

Question 1

What are you looking for on general inspection of the thyroid?

Answer 1

Weight: increased (hypothyroid), decreased (hyperthyroid)
Behaviour: anxiety/hyperactivity (hyperthyroid), low mood (hypothyroid)
Clothing: inappropriate for current temperature, (heat intolerance = hyperthyroid, cold intolerance = hypothyroid)
Hoarse voice: compression of larynx (thyroid enlargement)
Mobility aids: peripheral myopathy (hyperthyroid)

Question 2

What are you looking for on inspection of the hands in a thyroid exam?

Answer 2

Temperature
Palmar erythema (hyperthyroid)
Dry skin (hypothyroid)
Onycholysis (hyperthyroid)
Clubbing/thyroid acropachy: periosteal phalangeal over growth in Graves’ disease
Tremor with paper on hands (hyperthyroid)

Question 3

What are you assessing when checking the pulse in a thyroid exam?

Answer 3

Tachycardia (hyperthyroid)
Bradycardia (hypothyroid)
Irregular rhythm (hyperthyroid)

Question 4

What are you looking for on inspection of the face in a thyroid exam?

Answer 4

Dry skin (hypothyroid)
Outer eyebrow loss (hypothyroid)
Sweating (hyperthyroid)

Question 5

What are you looking for in the eyes in a thyroid exam?

Answer 5

Exophthalmos - inspect bulging from all angles (Graves’ disease)
Lid retraction - sclera visible above cornea (Graves’ disease)
Restricted eye movements - ask about pain and double vision in H shape (Graves’ disease)
Lid lag - delayed decent of upper lid when looking down (Graves’ disease)

Question 6

What are you looking for on inspection of the neck in a thyroid exam?

Answer 6

Scars
Masses:
- does it move when they swallow? (thyroid mass or thyroglossal cyst will move up, lymph node or invasive thyroid malignancy will not move)
- does it move when they protrude their tongue? (thyroglossal cysts will move up, thyroid masses will not move)

Question 7

How do you examine the thyroid?

Answer 7

• Stand behind the patient with their head tilted down and neck muscle relaxed
• Locate the cricoid cartilage and palpate the isthmus lying just under this
• Palpate each lobe by moving laterally from the isthmus (check for symmetry, consistency, and masses)
• Ask the patient to swallow water and protrude their tongue to check for symmetrical movement
• Auscultate the thyroid for bruit (increased vascularity in Graves’ disease)

Question 8

What else do you examine in a thyroid exam?

Answer 8

• Palpate lymph nodes for any enlargement
• Palpate trachea for deviation caused by large goitre
• Percuss the sternum (dullness = large thyroid mass extending posteroinferiorly)
• Asses knee jerk reflex (hyporeflexia = hypothyroid)
• Inspect for pretibial myxoedema (Graves’ disease)
• Assess proximal myopathy by asking them to stand from a chair with arms crossed (Graves’ disease)

Question 9

What further tests are needed for a thyroid exam?

Answer 9

Thyroid function tests (T3, T4, TSH)
ECG: rule out AF
US of neck: asses thyroid masses