Thyroid Status and Exam Flashcards
What may you see on general inspection of a patient with hyperthyroidism?
- agitated, restless patient
- sweating
- clothing suggesting heat intolerance
- thin hair
- underweight
What might you see on general inspection of a patient with hypothyroidism?
- pallor
- hair loss
- lack of facial expression
- loss of outer 3rd of eyebrows
- obese
What might you see on thyroid examination of a patient with post thyroidectomy hypothydroidism?
- General insepction: maybe signs of graves eye disease
- anxious, agitated, dressed inappropriately as hot (hyper)
- sleepy, slow movements, dressed inappropriately as cold (hypo)
- Voice and speech: quickly = hyper; hoarse voice and slow speech=hypo
- Neck: Thyroidectomy scar & impalpable thyroid gland
- eyes: signs of graves eye disease possible
graves eye disease signs = Change in the appearance of the eyes (usually staring or bulging eyes); A feeling of grittiness in the eyes; Dry or watery eyes; Dislike of bright lights; Swelling or feeling of fullness in one or both upper eyelids; Bags under the eyes; Redness of the lids and eyes; Blurred or double vision; Pain in or behind the eye, especially when looking up, down or sideways; Difficulty moving the eyes
What may you see on examinastion of a patient with a thyroglossal cyst?
- General inspection: Sperical neck lump in the midline
- Neck: small spherical lump that moves upwards on tongue protrusion
[The thyroglossal duct is an embryological anatomical structure forming an open connection between the initial area of development of the thyroid gland and its final position. It is located exactly mid-line, between the anterior 2/3 and posterior 1/3 of the tongue]
[A thyroglossal cyst is a fibrous cyst that forms from a persistentthyroglossal duct. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages. … Thyroglossal cysts develop at birth.]
What would you expect to find upon inspection of the neck in hyper/hypothyroidism?
- you may find a goitre in either hyper or hypo thyroidism
- or
- the thyroid gland maybe impalpable in hyper
- or
- normal in hypo
what may you find on inspection of the hands in hyper-thyroidism?
- Thyroid acropachy
- warm, excess sweating
- tremor
- palmar erythema
- tar staining
What may you find on inspection of the hands in hypo-thyroidism?
- cool
- low pulse rate
- irregular pulse due to heart block
What might you find on inspection of the eyes in hyper-thyroidism?
- exopthalmos
- proptosis
- opthalmoplegia (worst on upward gaze)
- conjunctival oedema
- corneal ulcers
- or even Normal
What might you find on inspection of the eyes in hypo-thyroidism?
- puffy eye lids
other hypo signs include ataxia, ascites and pleural effusions
What Signs may there be in hyper-thyroidism on inspection of the legs?
- pretibial myxoedema
- proximal myopathy
What signs may you see on inspecting the legs in hypo-thyroidism?
- ankle swelling
- slow relaxing reflexes
- proximal myopathy
What should be looked for on thyroid examination of the hands?
- inspect for palmar erythema (hyper)
- warmth,
- tar staining
- acropachy (phalangeal bone overgrowth- graves, hand swelling)
- & clubbing assoc w/acropachy
- Dry skin (hypo)
- increased sweating (hyper)
- examines for a tremor (using paper)
- checks pulse for rate and rhythm
- (tachy = hyper, brady = hypo; irregular = AF; thyrotoxicosis)
What should be examined in the face and eyes for a thyroid ex?
Inspect face for dry skin (hypo), sweating (hyper), eyebrows outer 3rd loss (hypo, rare)
- inspect eyes from front, sides and above for eye proptosis/exopthalmos & lid retraction (?visible sclera)
- inspect for any redness/inflammation of the conjunctiva
- ensure patient is able to shut eyes completely (if appropriate)
- test for opthalmoplegia (H–> drop finger down)
- test for lid lag (from exopthal in graves)
graves can give exopthal and restricted eye movement bc of abnorm connective tisue deposition in orbit and extra-ocular muscles
How do you examine the thyroid gland?
- Inspect:
- Skin changes e.g. erythema
- Scars? previous thyroidectomy scars can easily be missed
- identify neck swelling/masses in area –> assess size and shape [norm thyroid =/= be visible]
- examine for JVP, distended neck veins
- if mass is noted:
- water swallow - if in thyroid gland will move with swallow and so will thyroglossal cysts
- but lymph nodes will move LITTLE
- protrude tongue
- thyroid masses/lymph nodes will NOT move
- thyroglossal cysts WILL move upwards noticeably
- water swallow - if in thyroid gland will move with swallow and so will thyroglossal cysts
- if mass is noted:
-
Palpate:
- palpate lobes of thyroid [appropriate technique = stabilising ipsilateral lobe while palpating contralateral)
- at rest
- swallowing
- tongue protrusion
- assess tracheal deviation [e.g. due to large thyroid mass]
- palpate carotid pulses
- palpate cervical lymph nodes - [may suggest mets spread of thyroid malig] (supraclavicular, ant/post cervical chain, submental nodes)
- palpate lobes of thyroid [appropriate technique = stabilising ipsilateral lobe while palpating contralateral)
-
percuss
- downwards from sternal notch to detect retrosternal extension of goitre
- ascultates for bruits over thyroid [from inc vascularity e.g. graves]; then over aortic area to rule out radiated aortic stenosis murmur
- state intention to examine for pembertons sign (red face/cyanosis and resp distress after having arms up by head for ~1 min; where goitre “corks off” thoracic inlet = SVC syndrome)
What do you examine the legs for in thyroid ex?
- inspect for pretibial myxoedema
- test for proximal myopathy
- examine for slow relaxing knee reflex
