Thyroid Examination

Thyroid Gland Anatomy

Parathyroid Glands

RLN

Histology of Thyroid Gland

Histology of Thyroid Gland

Physiology of Thyroid Gland

Physiology of Thyroid Gland

Pathology of Thyroid Gland Hormone Hyperthyroidism Hypothyroidism Gland Nodule or Cyst Goiter

History of Thyroid Diseases Local Dysphagia Dyspnea Voice Pain Mass Neck fullness Systemic hyperthyroidism hypothyroidism Other Acropachy Ophthalmopathy Dermatopathy

Presentation of Thyroid Diseases

Steps of Clinical Examination 1- Privacy and Light Wash your hands 2- Introduce your self Clarify the patient’s identity 3- Explain the procedure and gain the patient’s acceptance Start the Examination

Wash your hands

Initial observation of the patient. Does he seems abnormally hyper- or hypoactive? Does he appears sweaty? What condition is their skin and hair? Does their voice sound normal?

Examine the hands Look for any tremor palmar erythema feel the hands for any sweating Look for any tremor palmar erythema Check the nails for any thyroid Acropachy : digital clubbing swelling of digits and toes & periosteal reaction of extremity bones feel the pulse

thyroid Acropachy :

thyroid Acropachy :

TED : Thyroid Eye Disease Eyes Examination TED : Thyroid Eye Disease Upper eyelid retraction (Darlimple's sign) Lid lag  Redness  conjunctivitis Exophthalmos Diplopia

Eyes Examination hypothyroidism Apathetic face Bilateral ptosis Loss of eyebrows laterally (Hertoge's sign) Periorbital edema

Neck Examination Inspection look from the front and the side looking pay particular attention to the area of the thyroid look for any obvious abnormalities

Neck Examination Palpation feel the gland The approach is from behind Palpate both lobes & the isthmus Note any swellings or lumps note the shape and consistency of any lumps as well as whether they are tender or mobile examine while the patient drinks to assess whether the lump moves with swallowing. examine the cervical lymph nodes examine the eyes from behind and above to look for any Exophthalmos Neck Examination

Neck Examination Auscultation auscultate the thyroid and carotid arteries for Bruit PALPATE THE Trachea looking for retrosternal goiter Percusse the manibruim for retrosternal goiter

Look for Pretibial Myexedema Lower Limbs Look for Pretibial Myexedema

Thank your patient and report your findings to the examiner

Then Order thyroid function TSH Free T3 Free T4 Thyroid Ultrasound FNAC

Thyroid function results interpretation Primary Hypothyroidism TSH: ↑ Free T3 and free T4: ↓ Secondary Hypothyroidism TSH: ↓ or ↔ Free T3 and free T4: ↓ Hyperthyroidism TSH: ↓  Free T3 and free T4: ↑