Basic Thyroid Examination

Transcription

1 Basic Thyrid Examinatin WIPE Wash hands Intrduce yurself Permissin Psitin (Patient sat in frnt f yu upright) Expsure (Neck expsed) Identify Patient (cnfirm the fllwing details befre starting) Name Age Date Inspectin Start with general inspectin Des the patient lk in pain? Is he/she cmfrtable? Is he/she fully aware f what is happening? Des the patient appear f nrmal clur? Overall build (BMI) Are there any indicative findings in the patient s surrundings? Is he/she dressed apprpriately given the current temperature (suggestive f heat r cld intlerance)? Inspect the Hands

2 Nails (Clubbing/Acrpachy) Tar staining? Temperature Sweaty palms? Palmar Erythema? Resting tremr (place a sheet f paper ver utstretched hands t help identify this) Vitals BP Pulse Cmment n Rate & Rhythm frm radial pulse Cmment n Vlume and character frm cartid pulse Temperature

3 Eyes Assess eye mvement using the H-plt (shwn previusly in Cranial Nerves Vide). Identify any abnrmalities including diplpia Lid Lag Lid Retractin Expthalmus (prptsis f endcrine rigin) Neck Identify any masses/lumps/asymmetry/scars/surface changes. If any mass is identified ask the patient t prtrude their tngue and assess whether this causes it t mve Assess whether the mass mves upn swallwing (thyrid swellings will mve upwards with swallwing). T d this, ask the patient t take a drink f water, hld it in their muth and then swallw n cmmand. Palpatin Palpate the thyrid frm either alng side r directly behind the patient. If yu chse the latter f these, be sure t warn the patient befre yu d s t avid startling them. Identify the isthmus and then lbes f the thyrid gland, define their bundaries (nte if these are irregular). If there is any ther defined swelling in the neck define the bundaries als. Ask the patient t swallw again whilst palpating the thyrid/any swellings.

4 When describing any lumps/swellings fund the fllwing shuld be cnsidered: Lcatin Size Cnsistency Tenderness Mbility Margins Transilluminatin Assess fr lymphadenpathy (nt perfrmed in vide) Percussin Percuss fr retrsternal gitre Auscultatin Auscultate ver the thyrid fr bruits. Abnrmal swellings f the neck may als cause bstructin f breathing (stridr)

5 Final Pints: Pre-tibial Myxedema: Relatively rare but ccurs in a small percentage f patients with Grave s Disease. Reflexes: Ankle Jerk is the ptin usually taught at student level s fr simplicity sake we can stick t this fr nw. Many students find it easiest t elicit this as shwn in the vide, hwever remember in the real wrld this methd may nt always be apprpriate, especially in the elderly. Prximal Limb weakness (mypathy): May be assciated with hyperthyridism. Thyrid activity Nrmal Activity Euthyrid Excessive Activity Hyperthyrid Under Activity Hypthyrid

6 T cnclude yur examinatin yu shuld cnsider/include: Blds (Free T 3 /T 4, TSH, chlesterl, prlactin levels, antithyrid antibdies etc) Examinatin f ther systems (e.g. Cardivascular/Carpal tunnel syndrme) Inclusin f ther systems in histry (e.g. reprductive r gastr-intestinal systems) Thyrid ultrasund scan Bipsy Fine Needle Aspiratin Example f hw t reprt clinical findings General Findings This is Sarah James a 45 year ld wman wh presented with..... On examinatin I fund... Imprtant Psitive Findings List these ff Imprtant Negative Findings Hwever, there was n... (these shuld be thse relevant t ruling ut differentials) Clinical Cnclusins These findings are cnsistent with... Then be prepared t explain hw yu wuld like t prceed (investigatins and management etc)