Thyroid Exam

## The Thyroid Exam

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### Vital Signs

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* HR (brady/tachycardia)
* BP (wide pulse pressure)

### Inspection

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* medial and inferior, isthmus crosses trachea between 2nd and 4th tracheal ring
* each lobe should be no larger than the distal phalanges of the patient’s thumb
* obliteration of the medial borders of SCM muscles
* have the patient slightly extend their neck and to swallow a sip of water
* assess for a ≥ 2 mm increase in the horizon of the lateral view of the neck over the area of the thyroid isthmus, especially if it moves upwards during swallowing
* assess for asymmetry, masses, erythema, deviation of the trachea

### Palpation

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* cervical nodes, tracheal deviation
* CAROTID PULSE - absence indicates malignant thyromegaly (Berry’s Sign)
* Tenderness
* start from under the suprasternal notch, medial the SCM

#### Anterior Approach

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* face the patient sitting, have pt turn head to relax a SCM; with your hand, displace the trachea to that side and palpate while she swallows

#### Posterior Approach

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* index finger just below the cricoid
* displace trachea and palpate as the patient swallows

* DESCRIBE: size, symmetry, consistency

### Auscultation

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* over thyroid lobes for a BRUIT (thyrotoxicosis)

### Special Tests

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PEMBERTON’S TEST

* elevate, extend, rotate both arms for 3 min
* goiter → presyncope, SOB, cyanosis, plethora (compression of artery and veins)

## Videos of Proper Examination

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* Medical Examination of thyroid Gland
* Surgical Examination of a thyroid swelling
* Examination of clinical status of thyroid hormones

## Signs and Symptoms of Thyrotoxicosis

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### General

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* fatigue
* agitation, nervousness
* heat intolerance

### GI

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* ↓ weight
* diarrhoea

### Dermatological

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* warm and moist skin
* fine hair
* thyroid acropatchy (clubbing)
* onycholysis
* pretibial myxedema

### Cardiovascular

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* tachycardia
* ↑ pulse pressure, systolic outflow tract murmurs
* a fib

### Neurological

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* fine tremor - place piece of paper on patient's outstretched hand
* hyperreflexia

Insomnia, restlessness, irritability

### Musculoskeletal

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* proximal muscle weakness

### Opthalmologic

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* lid lag
* stare with ↓ blink
* widened palpebral fissures

#### Grave's Disease Opthalmopathy

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* proptosis/exopthalmos - bulging eye
* chemosis - eye irritation
* EOM dysfunction (up gaze)
* corneal ulcerations
* optic nerve entrapment

rosenbach;s sign fine tremoreson closure eye lid

## More OSCE Modules

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* v
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* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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