Thyroid case examination

Thyroid case examinationCreated OnApril 16, 2020Last Updated OnOctober 28, 2020byadmin You are here: Main Clinical Examination Thyroid case examination < All Topics Table of Contents Thyroid case examination General Examination General condition: presence of anaemia, respiratory distress, nutritional status Thyrotoxicosis: thin and underweight Hypothyroidism: obese and overweight. Also has mask like facies in severe hypothyroidism Carcinoma : anaemia and cachexia Local Examination Inspection(Swelling) Number: single (diffuse), multiple (multi-nodular goitre) Site: midline swelling or lateral swelling (as above) Size: estimate on inspection, measure in palpation Shape: butterfly (Diffuse), hemispherical (Nodule) Surface: smooth(colloid) or bosselated(multi-nodular goitre) Skin over swelling: any sign of inflammation, any dilated vein Pulsation: presence in some primary toxic goitre Movement with deglutination – differentials as above Why does thyroid gland move with deglutination? Pretracheal fascia which encloses thyroid is attached to the hyoid bone Ligament of Berry : thickened pretracheal fascia postero-medially attached to the cricoids cartilage Isthmus has some attachment with trachea directly In cases of anaplastic tumours, fixation due to previous surgery, retrosternal goitre or Reidel’s thyroiditis: thyroid swelling will presence with variety degree of movement restriction Movement with protrusion of tongue (only seen in thyroglossal cyst) Dilatation of subcutaneous veins on upper anterior thorax: retrosternal extension with superior vena cava (SVC) obstruction. Pamberton Sign : to diagnose retrosternal goiter with SVC obstruction Raise both arms over head, until touch ears and maintain for a while: positive if congestion of face and distress seen due to obstruction of (SVC) Pizzilo’s method: in case of short neck individual and obese, ask the patient to keep the hands behind the head and ask to push head backwards against clasped hand will make small nodules prominent. Palpation: (neck slightly flexed position) Palpate from front Confirm inspection findings : number, site, size, shape of the swelling Surface: smooth (colloid, Grave’s disease), bosselated (Multinodular Goitre) Consistency : soft (colloid, Grave’s Disease), firm (Multinodular goitre, Solitary Nodular goitre), hard (Carcinoma, Reidel’s thyroiditis) Mobility :restricted in carcinoma and chronic thyroiditis Skin attachment ( may be present in advance cancer) Palpate the lower border by asking patient to swallow water. In retrosternal extension lower pole can’t palpate. Pressure effect : Tracheal position (put Index and ring finger over clavicle head and try to access position of the trachea by middle finger) Can use Trial Sign : prominence of sternocleidomastoid on the side of deviation of trachea Kocher’s sign : positive when there is stridor if gland is pushed medially from lateral side of the swelling Berry sign : unable to feel carotid pulse ( in case of Carcinoma due to infiltration of the carotid sheath) Lahey’s method: Push the lateral side of one lobe and try feel the other lobe (easier to palpate) Crile’s method: place one thumb on thyroid while patient swallows, useful to diagnose doubtful nodules Palpate from back Similar as above mentioned above during palpation from front. Palpate for cervical lymphadenopathy/Levels of nodes involved if any Easier way of examining lymph nodes in neck are – submental, submandibular, anterior cervical, supraclavicular, posterior cervical, occipital, pre-auricular, post-auricular Percussion Retrosternal extension : percussion over manubrium sternum to detect dullness *Auscultation over thyroid swelling may revealed vascular bruit in case of primary thyrotoxicosis Neck nodes by region Level 1 SUBMANDICULAR AND SUBMENTAL Below myohyoid muscle and above the lower margin of the hyoid bone Anterior to the posterior border of the submandibular glands Level Ia : sub mental – between the anterior bellies of the digastric muscle Level Ib : sub mandibular – posterolateral to the anterior belly of digastrics Level 2 UPPER JUGULAR Jugulodigastric Base of skull to lower margin of hyoid bone Anterior to the posterior border of sternocleidomastoid (SCM) Posterior to the posterior border of the submandibular glands Level IIa : anterior, lateral, or medial to the vein or posterior to the internal jugular vein and inseparable from it. Level IIb : posterior to the internal jugular vein and have a fat plane separating the nodes and the vein Level 3 MIDDLE JUGULAR Lower margin of hyoid to lower margin of cricoid cartilage Anterior to the posterior border of sternocleidomastoid Lateral to the medial margin of the common carotid artery / internal carotid artery Level 4 LOWER JUGULAR Lower margin of cricoid cartilage to level of the clavicle Anterior and medial to an oblique line drawn through the posterior edge of the sternocleidomastoid muscle and the posterolateral edge of the anterior scalene muscle Lateral to the medial margin of the common carotid artery Level 5 POSTERIOR TRIANGLE – include supraclavicular nodes Level Va :...

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