Thyroid Exam

Vital Signs

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

Inspection

 * 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

 * 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

 * 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

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


 * DESCRIBE: size, symmetry, consistency

Auscultation

 * over thyroid lobes for a BRUIT (thyrotoxicosis)

Special Tests
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

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

General

 * fatigue
 * agitation, nervousness
 * heat intolerance

GI

 * ↓ weight
 * diarrhoea

Dermatological

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

Cardiovascular

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

Neurological
Insomnia, restlessness, irritability
 * fine tremor - place piece of paper on patient's outstretched hand
 * hyperreflexia

Musculoskeletal

 * proximal muscle weakness

Opthalmologic

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

Grave's Disease Opthalmopathy
rosenbach;s sign fine tremoreson closure eye lid
 * proptosis/exopthalmos - bulging eye
 * chemosis - eye irritation
 * EOM dysfunction (up gaze)
 * corneal ulcerations
 * optic nerve entrapment