1. BISMILLAHIRRAHMANIRRAHIM PHYSICAL EXAMINATION OF THYROID DISEASE SITI ANNISA DEVI TRUSDA

2. 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

3. Anatomy of Thyroid Gland

5. Physical Examination Assess the patient’s 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

6. Exophthalmos

7. Assess the thyroid and pretracheal lymph nodes examination Examination of thyroid gland : Observe the neck, especially as the patient swallows

8. Diffuse Goiter

9. Unilateral Swelling

10. 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

11. Palpation from the front

12. 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 patient’s 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

13. Palpation from behind

14. 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

15. 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

16. Assess the abdominal condition : slowed or rapid peristaltic Assess the extremitas condition : Tremor Thyroid dermopathy Moist hand, warm Dry skin Myxedema

17. Dermopathy

18. Assess the neuromuscular system Slow reflexes Hyper reflexes Assess the musculoskeletal system Muscular weakness

26. LID RETRACTION