Thyroid Examination Wail Alamoudi General examination Local examination

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Thyroid Examination Wail Alamoudi

Thyroid Examination Wail Alamoudi

 • General examination • Local examination

• General examination • Local examination

Local examination • Inspection • ( at rest , tongue , swallowing , raising

Local examination • Inspection • ( at rest , tongue , swallowing , raising both hands ) • Palpation • Percussion • Auscultation

Inspection at rest • Tip the patients head back a bit • Inspect thyroid

Inspection at rest • Tip the patients head back a bit • Inspect thyroid gland & scar • A visibly enlarged thyroid gland is called a goiter. • Note whether it is visible and symmetrical

Is This a Thyroid? • Ask patient to stick tongue out while palpating: Should

Is This a Thyroid? • Ask patient to stick tongue out while palpating: Should NOT move • Ask patient to swallow water: Should move Thyroglossal cyst

Inspection while raising hands 1. pemberton's sign ( retrosternal goiter ) development of facial

Inspection while raising hands 1. pemberton's sign ( retrosternal goiter ) development of facial flushing, distended neck and head superficial veins, inspiratory strider and elevation of the jugular venous pressure (JVP) upon raising of the patient's both arms above head 2. Proximal myopathy

palpation ANATOMIC BONDARIES OF THYROID • Cricoid cartilage • Suprasternal notch • Carotid arteries

palpation ANATOMIC BONDARIES OF THYROID • Cricoid cartilage • Suprasternal notch • Carotid arteries

ANATOMIC RELATIONSHIPS OF THE THYROID

ANATOMIC RELATIONSHIPS OF THE THYROID

Palpation

Palpation

Palpation • • • Palpate thyroid gland from behind Localize anatomic boundaries Thyroid isthmus

Palpation • • • Palpate thyroid gland from behind Localize anatomic boundaries Thyroid isthmus is often palpable Thyroid lobes are barely or not palpable The consistence is rubbery, similar to that of sternomastoid muscle

Classical Clinical Examination The following information could be obtained ývolume ýconsistency ýmobility of the

Classical Clinical Examination The following information could be obtained ývolume ýconsistency ýmobility of the thyroid gland ýsurface ýtemperature ýsensibility

Percussion On the upper part of the manubrium looking for retrosternal goiter

Percussion On the upper part of the manubrium looking for retrosternal goiter

Auscultation Looking for bruit over each thyroid lobe

Auscultation Looking for bruit over each thyroid lobe

 • General examination • Local examination

• General examination • Local examination

General inspection • • body built Eyes & Face Hands Arms & Legs

General inspection • • body built Eyes & Face Hands Arms & Legs

body built • Thin • Obese

body built • Thin • Obese

Face 1. malar flush 2. Hair loss Eyes 1. 2. 3. 4. Exophthalmos Lid

Face 1. malar flush 2. Hair loss Eyes 1. 2. 3. 4. Exophthalmos Lid retraction Lid lag Xanthelasma

Hands 1. 2. 3. 4. 5. 6. 7. 8. Sweaty hand Temperature Acropachy (clubbing)

Hands 1. 2. 3. 4. 5. 6. 7. 8. Sweaty hand Temperature Acropachy (clubbing) Onycholysis( plummer’s nails ) Palmer erythema vitiligo Tremor Pulse

Legs and Arms • Proximal myopathy • Reflexes • Pretibial myxedema

Legs and Arms • Proximal myopathy • Reflexes • Pretibial myxedema

Wail Alamoudi 0504649662

Wail Alamoudi 0504649662

 • Identify the cricoid cartilage with the fingers of both hands. • Move

• Identify the cricoid cartilage with the fingers of both hands. • Move downward two or three tracheal rings while palpating for the isthmus. • Move laterally from the midline while palpating for the lobes of the thyroid. • Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. The normal gland is often not palpable.