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2b > Thyroid Examination > Flashcards

Thyroid Examination Flashcards

1
Q

What is lingual thyroid

A

Where the thyroid does not descend down the neck during development.

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2
Q

Which arteries run either side of the thyroid

A

Carotid arteries

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3
Q

What are the three presentations of thyroid disease

A
  • lump in neck or mass effect
  • hyperthryoidism
  • hypothyroidism
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4
Q

How does hypothyroidism normally present

A

Goitre

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5
Q

Questions when someone presents with lump in neck

A

When did it start?
How quickly is it changing?
Any family history?
Is there any pain?

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6
Q

What questions would you ask about the pain in the neck

A

Just in the enlargement?
Whole region of gland?
Slow onset or sudden?

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7
Q

What questions to ask when someone has goitre?

A

Difficulty breathing?
Difficulty swallowing?
Pain?
Incidental finding on CT/CXR

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8
Q

Neck pain
Neck Swelling
High temperature

A

Thyroiditis

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9
Q

Initial treatment for overactive thyroid

A

Beta blockers

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10
Q

Are there any contraindications for starting someone on beta blockers before you have confirmed hyperthryoidism

A

No

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11
Q

Symptoms of hypothyroidism

A 
Tiredness
Weight gain
Lethargy
Lack of concentration
Depression
Cold intolerance
Headahces
Menorrhagia
Constipation
Dry skin
Hoarse voice
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12
Q

Questions for hypothyroidism

A

How long have symptoms been present?
Speed of onset?
Medication?
Family history of AI

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13
Q

Which medications are associated with hypothyroidism

A

Amiodarone and lithium

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14
Q

Which AI conditions are most strongly associated with hypothyroidism

A

Thyroid and B12 deficiency

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15
Q

Primary causes of hypothyroidism

A 
Dyshormogenesis
Iodine deficiency
Autoimmunity
Post radioactive iodine
Post thyroidectomy
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16
Q

Secondary causes of hypothyroidism

A

Pituitary tumours
Pituitary granulomas
Empty sella

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17
Q

Tertiary causes of hypothyroidism

A

Isolated TRH deficiency

Hypothalamic disorders

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18
Q

Who gets hypothyroidism screening

A

T1DM
Pernicious anaemia
Addisons
Vitiligo

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19
Q

Hyperthryoidism symptoms

A 
Weight loss 
• Sweating
• Palpitations (AF in more elderly)
• Tremor
• Preference for cool environment
• Anxiety
• Lack of concentration
• Diarrhoea/loose stool
• Oligo/amenorrhoea
• Muscle weakness
20
Q

Which eye state is a sign of all hypethryoidism types

A

Lid lag

21
Q

Questions for hyperthryoidism

A

How long have symptoms been present?
Speed of onset?
Medication?
Family history?

22
Q

Common causes of hyperthyroidism

A

AI disease
(Graves disease, postpartum thryoiditis)
Toxic nodular goitre
Toxic adenoma

23
Q

Rare causes of hyperthryoidism

A

Amiodarone
De Quervains
Thyrotroph adenoma
hCG hyperthryoidism

24
Q

Graves specific features

A

Thryoid eye disease
Thyroid acropachy
Pre tibial myxoedema

25
Q

Thyroid eye disease

A

Exopthalmos
Thyroid acropachy
Pretibial myxoedema

26
Q

What are the first things you do in an examination

A

Consent
Wash hands
Ask about pain

27
Q

What is included in the general exam

A

Can they walk?
Face patient
General appearance

28
Q

Examination of hands

A

Inspect hands

  • sweating
  • palmar erythema
  • clubbing
  • brittle nails
  • pulse
  • tremor
29
Q

How do you examine the tremor

A

Put a sheet of A4 on their hands

30
Q

How do you look for the thryoid

A

Inspect neck
Patient drinks, does it move?
Ask patient to project tongue and open mouth

31
Q

What does a midline cyst that moves up suggest

A

Thyroglossal cyst

32
Q

How do you palpate the mass

A

Palpate thryoid
Palpate trachea
Ask patient to drink water, palpate the movement

33
Q

What are you examining about a mass

A 
Size
Shape
Surface
Consistency
-soft, firm, hand
fixed?
above and below?
any lymph enlargement?
34
Q

How do you examine the thyroid with your hands

A

Flex at the MCP

35
Q

How do you examine exopthalmos

A

Look at them from above

36
Q

How do you examine the eys

A 
Evidence of thryoid disease
Conjuctival oedema
Eye movements
Acuity and fundoscopy
Check for lid lag
37
Q

How do you check for lid lag

A

Ask patient patient to follow your hand up as you look from the side then follow it down

38
Q

When you auscultate and get a bruit what does that suggest

A

Graves as hypervascular

39
Q

Does graves disease have to have hyperthryoidism

A

No, they can present with eye signs only

40
Q

Apart from the head and neck where do you examine

A

The feet and shins for pretibial myxoedema which is a sign of graves

41
Q

What does proximal muscle weakness suggest

A

Could be hyperthyroidism or hypothryoidism

42
Q

How do you finish a thyroid exam

A

Check ankle or brachial reflexes

Thank the patient

43
Q

Hypothyroidism reflexes

A

Slow relaxing reflex

44
Q

Hyperthyroidism reflexes

A

Brisk

45
Q

Steps of thryoid exam

A
  • introduce
  • wash hands
  • ask for pain
  • inspect
  • look at hands and feel
  • examine pulse
  • look for tremor
  • full eye exam (H and lid lag)
  • neck (swallow then tongue)
  • palpate patient from behind
  • auscultate
  • assess proximal weakness
  • inspect shins
  • thank the patient

2b (28 decks)

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