BISMILLAHIRRAHMANIRRAHIM PHYSICAL EXAMINATION OF THYROID
DISEASE SITI ANNISA DEVI TRUSDA
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INTRODUCTION Once diabetes is excluded, thyroid disease
constitute the main bulk of endocrine problems have to sort out
during the clinical practice. Presents with : Excessive hormonal
activity hyperthyroidism Under production of the hormone
hypothyroidism CC: swelling of the neck
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Anatomy of Thyroid Gland
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Physical Examination Assess the patients level of
consciousness, blood pressure, pulse rate, respiration,
temperature, height, body weight and BMI Assess the Face and Eyes
examination : Lid retraction, Periorbital edema, Exophthalmos,
Puffy face, Hoarse, husky voice
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Exophthalmos
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Assess the thyroid and pretracheal lymph nodes examination
Examination of thyroid gland : Observe the neck, especially as the
patient swallows
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Diffuse Goiter
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Unilateral Swelling
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Examine from front of patient : to palpate the right lobe :
palpate with your left thumb while fixating the left lobe with your
right thumb rotate the gland slightly with one thumb while
palpating the other lobe with the other thumb same principle for
the other lobe
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Palpation from the front
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Examine from behind the patient : ask the patient to flex the
neck slightly forward to relax the sternocleidomastoid muscles
place the three fingers of both hands on the patients neck so that
your index fingers are just below the cricoid cartilage ask the
patient to sip and swallow water as before. Feel for thyroid
isthmus rising up under your finger pads
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Palpation from behind
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displace the trachea to the right with fingers of left hand,
palpate lateral part of right lobe thyroid gland with the fingers
of the right hand, palpate in the space between the displaced
trachea and the relaxed sternocleidomastoid muscle, find the
lateral margin. In similar fashion, examine the left lobe. The
lobes are somewhat harder to feel than the isthmus if the thyroid
is enlarged, auscultation for listen bruit by placing bell
stethoscope above the lateral part of thyroid gland
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The size of thyroid nodules can be measured by first drawing
and outline on the skin Assess the cardiac condition : Bradycardia
and tachycardia Assess the pulmonal condition : Slow respiration,
shortness of breath
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Assess the abdominal condition : slowed or rapid peristaltic
Assess the extremitas condition : Tremor Thyroid dermopathy Moist
hand, warm Dry skin Myxedema
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Dermopathy
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Assess the neuromuscular system Slow reflexes Hyper reflexes
Assess the musculoskeletal system Muscular weakness
