Clinical Thyroid Examination

Things you saw and discussed when you spent time with a bunch of mates from police department.

Brain sizes.

Some homosapien's brain is still in the size of a cat's brain.Otherwise raping and torturing young kids wouldn't happened in the first place 

Something that if turn out to be positive will bring negative consequences.

Gooseberries 🤤

After 17 hours of Intermittent fasting.

Cardio time.

Not ready to cut my hair for the sake of convo.Lets skip that convocation.

Weather is torturous but keep going.

I posted the types of neck swellings.

Click here.

Let's focus with the clinical thyroid examination.

     Clinical Thyroid Examination

Well,we can use these examination method to inspect thyroid lumps,goiter or even nodule.

Examination:

Inspection

For inspection,we will do it in two views but three time. Confusing?Okay,to simplify:

FRONT-BACK- FRONT 

FRONT

Inspect the gland in the anterior aspect of the neck.

Remember DTTT

1.Moves with deglutition-moves up or didn't move with deglutition

2.Temperature-raised or not

3.Tenderness-tender or non tender

4.Tracheal position.

If retrosternal extension;

Raise both hand over the head and wait for few minutes then search for

-Congestion of face,cynosis, respiratory distress

-Inspiratory stridor

(Due to obstruction of great vein in the thoracic inlet)

Now,from BACK.

Patient's neck is slightly flexed,four finger infront and thumb placed behind the next.

Ask the patient to swallow.

1.Palpate the lower limit of thryoid.

2.Size,surface , consistency

3.Overlying skin

4.Moves with underlying structure.

Fix the sternomastoid muscle by pressing the chin in examiner hand and feel if-

-thyroid deeps under sternomastoid 

-mobile or not

From this,you can make some smart guess.

*If Diffuse goiter:smooth surface,soft consistency

*If multinodular goiter:Bosselated surface, variegated consistency

*In primary thyrotoxicosis or hashimotos:

*Disease-Firm

*Colloid goiter-Soft

*Malignancy-Hard

5.Berres sign(see carotid artery)

In malignancy,carotid sheath is infiltrated by malignant cell so carotid pulsation cannot be found.

6.Kocher test(when thryoid is enlarged enough)

Slight push of lateral lobe compress the trachea and produce inspiratory stridor.

7.Palpation of cervical lymph nodes.

8.See above the head for exophthalmos.

Now FRONT again.

-Palpate the palm of the hand for any moisture.

-Look for tremor.

-Record the pulse

-If patient is thyrotoxic,look for thrill and bruit in superior thyroid pedicle in the superior aspect of the lateral lobe.

- Auscultate the heart.

Eye Sign

1.Lid retraction

2.Absent wrinkling

3.Lid lag

4.Failure of convergence

5.Staring look & infrequent blinking

Dalrymple's sign(Lid retraction)

See straight forward towards eye. Upper sclera is visible due to retraction of the eyelid.

Joffroy's Sign(Absent of wrinkling)

Ask the patient to see upwards.

Absence of wrinkling is the sign.

Von Graefe's Sign(Lid Lag)

Finger moves downward,upper  eyelid lags behind the eyeball as patient looks downwards.

Moebius Sign(Convergence failure)

Finger moves towards the middle, failure of convergence of eye.

Stelwag Sign(Staringlook)

Staring look and infrequent blinking and widening of palpebral fissure.

Proptosis

Bulging eye or exophthalmos is due

to increase retro orbital fat and enlarged intraorbital muscles infiltrated with lymphocytes and containing increase water and mucopolysaccharides .

Simple definition