Introductory course 2019 Thyroid Gland History Principles Physical

Introductory course 2019 Thyroid Gland

History. Principles : Physical Examination. Investigations

• Clinical diagnosis is an art, and the mastry of an art has no end, you can always be a better diagnostician. “Logan Clendening” • There can be no substitute for detailed appraisal of the history and physical signs. ” Harrold Ellis”

Importance Thyroid Gland Structure Function

Inspection • Should never be hurried • Thin patients • Short neck and obese (Pizzillo) • Movement

• From the back • Chin lowered • Systemic approach Palpation • Gland limits • Inclination to the side examined • Extend the neck • Whole gland • Surface • Nodules • Lateral displacement • Localised swelling Examine from the front

Symptoms Obstruction Kochers test

Primary (Graves disease) Relatively young females Hyperthyroidism Gland enlarged symmetrically Exophthalmos in more than 50% of patients

Weight loss Skin moist Tachycardia Primary hyperthyroidism…. . Contd AF Intolerance to hot weather Tremor Thrill Systolic murmur

Older patients Longstanding multinodular goitre or adenoma Secondary Hyperthyroidism Eye signs are almost invariably absent AF is common Cardiac decompensation

Not necessarly a disease of the old. Young patients including children. The malignant thyroid Loss of mobility. Berrys sign. Horners syndrome. Horseness. Enlarged lymph nodes.

Fullness. Dilated veins. Retrosternal Goitre Palpation. Percussion.

Mental slowness. Puffiness. Ill marked outer eyebrows. Feeling cold. Hypothyroidism (myxoedema) Face bloated look. Substantial loss of hair. Voice slow. Slow pulse. Temperature often subnormal. Subcutaneous tissues firm and podgy

• Hashmoto’s thyroiditis Rubbery gland • Reidle’s thyroiditis Hard • Goitre in infancy Special situations Endemic areas Teratoma Antithyroid drugs during pregnancy • Lingual thyroid. • Physiological goitre. • Subacute thyroiditis (de Qurvains thyroiditis).

Eye signs in thyroid disease • Ranges from staring to obviously protruding. • Both eyes are not necessarily affected. • Mild disease • Lid retraction( Stelwags). • Naffzigers Method. • Lid lag (Von Graefes).

Eye signs …. . Contd • Moderate exophthalmos • Joffroys sign. • Intraorbital congestion. • Increased resistance to light pressure. • Diplopia. • Difficulty in convergence (Myebius)

Symptomatology Hyperyhyroidism Preference for cold weather Excessive sweating Increased appetite Hypothyroidism Intolerence to cold Decreases sweating Hoarseness Weight loss Anxiety Tiredness Diarrhoea Palpitations Oligomenorrheoa Weight gain Slow cerebration Tiredness and decreased energy Constipation Muscle pains

Physical findings Hyperthyroidism Hypothyroidism Goitre Pallor or slightly yellow skin Exophthalmos Puffiness Lid retraction Loss of outer third eyebrows Warm moist palms Dry thickened skin and hair Tremor Dementia(Myxoedema madness) Onycholyses Slow-recovery phase of ankle jerk AF Nerve deafness, Coma Slow pulse Pretibial myxoedema Large tongue Peripheral oedema