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ENDOCRINE EXAMINATION: THYROID
Wimpie de LangeDiv. of Endocrinology
Dept. of Internal Medicine
April 21, 2023
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ENDOCRINE EXAMINATIONThe Thyroid
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INSPECTION
The isthmus of the thyroid can be visible in a very thin patient.
Swallow Swallow water: Thyroid moves
Scars (thyroidectomy)
Dilated neck veins
Redness
Lymph nodes
Stick out tongue
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PALPATION
Size
Form/ consistency
Tenderness
Mobility
Repeat when patient swallows water
Cervical lymph nodes and carotid arteries
[Site/ Size/ Shape/ Colour/ Contour/ Consist./ Temp./ Tender/ Nodes/ ]
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PERCUSSION AND AUSCULTATION
Percuss for a retrosternal thyroid.Auscultate for a bruit.
Pemberton’s sign: Pemberton’s sign: patient lifts his/her arms above the head:
Cyanosis/ congestion of the faceRespiratory distress/ stridorEngorgement of neck veinsSyncope
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SIGNS OF HYPERTHYROIDISM
Signs of weight lossAnxietyHands: Fine tremors, onycholysis (Plummer’s nails), thyroid acropachythyroid acropachy, palmar erythema, skin warm and clammy.Pulse: Sinus tachycardia, atrial fibrillation, hyperdynamic circulation.Chest: Heart murmur22, heart failureLegs: Pre-tibial myxoedemaPre-tibial myxoedema, Proximal muscle weakness and increased reflexes.
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EYE SIGNS
Sympathetic overactivity: staring gaze, lid retraction, lid lagPtosisExophthalmos ChemosisConjunctivitisCorneal ulcerationOptic atrophyOphthalmoplegia
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HYPOTHYROIDISM
Signs of general lethargia
Hands: peripheral cyanosis, swelling of the skin, skin feels cool and dry, anaemia, hypercarotenaemia, Tinel’s sign (carpal tunnel syndrome)
Pulse: slow, small volume
Proximal muscle weakness and decreased (slow) reflexes.
Face: Skin thickened, alopecia, vitiligo, periorbital oedema, Quenn Anne sign, xanthelasma, hair dry, skin coarse, nerve deafness.
Chest: pleural and pericardial effusion.
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