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Thyroid Examination

From Mediwikis

Wash Hands

OSCE examination of the Thyroid Gland, Courtesy of AllAccessMedicine.

Introduction, Explanation, Consent

  • Voice changes

General Inspection

  • Generally well
    • Restless and agitated [Hyper]
    • Slow and lethargic [Hypo]
  • Goitre
  • Dry skin and hair [Hypo]

Hands

  • Fine tremor [Hyper]
    • Place piece of paper on hands
  • Sweating [Hyper]
  • Thyroid Acropachy (clubbing) [Grave's]

Pulse

  • Rate, Rhythm, Volume
    • Tachycardia & Atrial Fibrilliation [Hyper]
    • Bradycardia [Hypo]

Eyes

  • Lid lag
  • Lid retraction [Grave's]
  • Periorbital myxoedema [Hypo]
  • Proptosis/Exopthalmos (from behind and above)
  • Diplopia

Patient Swallowing Water

  • Thyroid gland and thyroglossal cysts move upwards on swallowing

Patient Sticking Tongue Out

  • Thyroglossal cysts only move upwards in this case

Palpation (From Behind, Ask Patient To Relax Neck Muscles)

  • Feel gland with index fingers
    • Size
    • Shape
    • Consistency
    • Tenderness [Diffuse = viral thyroiditis, Localized = bleeding into thyroid cyst]
    • Palpable thrill from gland [Hyper]
    • If large goitre, measure maximium neck circumference with tape measure
    • Feel gland move upwards during swallowing
  • Auscultate over lobes for a thyroid bruit (carotid bruits are louder over artery)

Lower Limbs

  • Pretibial myxoedema [Grave's]

Patient Stands Up With Arms Crossed

  • Proximal muscle weakness

Reflexes

  • Delayed muscle relaxation [Hypo]

Wash Hands