BISMILLAHIRRAHMANIRRAHIM PHYSICAL EXAMINATION OF THYROID DISEASE SITI ANNISA
BISMILLAHIRRAHMANIRRAHIM PHYSICAL EXAMINATION OF THYROID DISEASE SITI ANNISA DEVI TRUSDA
INTRODUCTION • Once diabetes is excluded, thyroid disease constitute the main bulk of endocrine problems have to sort out during the clinical practice. Presents with : • Excessive hormonal activity hyperthyroidism • Under production of the hormone hypothyroidism • CC: swelling of the neck
Anatomy of Thyroid Gland
Anatomy of Thyroid Gland
Physical Examination • Assess the patient’s level of consciousness, blood pressure, pulse rate, respiration, temperature, height, body weight and BMI • Assess the Face and Eyes examination : Lid retraction, Periorbital edema, Exophthalmos, Puffy face, Hoarse, husky voice
Exophthalmos
Assess the thyroid and pretracheal lymph nodes examination Examination of thyroid gland : • Observe the neck, especially as the patient swallows
Diffuse Goiter
Unilateral Swelling
Examine from front of patient : • to palpate the right lobe : palpate with your left thumb while fixating the left lobe with your right thumb • rotate the gland slightly with one thumb while palpating the other lobe with the other thumb • same principle for the other lobe
Palpation from the front
Examine from behind the patient : • ask the patient to flex the neck slightly forward to relax the sternocleidomastoid muscles • place three fingers of both hands on the patient’s neck so that your index fingers are just below the cricoid cartilage • ask the patient to sip and swallow water as before. Feel for thyroid isthmus rising up under your finger pads
Palpation from behind
• displace the trachea to the right with fingers of left hand, palpate lateral part of right lobe thyroid gland with the fingers of the right hand, • palpate in the space between the displaced trachea and the relaxed sternocleidomastoid muscle, find the lateral margin. • In similar fashion, examine the left lobe. The lobes are somewhat harder to feel than the isthmus • if the thyroid is enlarged, auscultation for listen bruit by placing bell stethoscope above the lateral part of thyroid gland
• The size of thyroid nodules can be measured by first drawing and outline on the skin Assess the cardiac condition : • Bradycardia and tachycardia Assess the pulmonal condition : • Slow respiration, shortness of breath
• Assess the abdominal condition : slowed or rapid peristaltic • Assess the extremitas condition : • Tremor • Thyroid dermopathy • Moist hand, warm • Dry skin • Myxedema
Dermopathy
Assess the neuromuscular system • Slow reflexes • Hyper reflexes Assess the musculoskeletal system • Muscular weakness
LID RETRACTION
LID RETRACTION
ALHAMDULILLAH Selamat Berlatih
- Slides: 28