1. Thyroid Examination Wail Alamoudi

2. General examination Local examination

3. Inspection ( at rest, tongue, swallowing, raising both hands ) Palpation Percussion Auscultation

4. Tip the patients head back a bit Inspect thyroid gland & scar A visibly enlarged thyroid gland is called a goiter. Note whether it is visible and symmetrical Inspection at rest

5. Is This a Thyroid? Ask patient to stick tongue out while palpating: Ask patient to swallow water: Should NOT move Should move Thyroglossal cyst

6. Inspection while raising hands 1.pemberton's sign ( retrosternal goiter ) development of facial flushing, distended neck and head superficial veins, inspiratory strider and elevation of the jugular venous pressure (JVP) upon raising of the patient's both arms above headflushingstriderjugular venous pressure 2. Proximal myopathy

7. ANATOMIC BONDARIES OF THYROID Cricoid cartilage Suprasternal notch Carotid arteries palpation

8. ANATOMIC RELATIONSHIPS OF THE THYROID

9. Palpation

10. Palpate the thyroid gland from behind Localize anatomic boundaries Thyroid isthmus is often palpable Thyroid lobes are barely or not palpable The consistence is rubbery, similar to that of sternomastoid muscle

11. Classical Clinical Examination The following information could be obtained ývolume ýconsistency ýmobility of the thyroid gland ýsurface ýtemperature ýsensibility

12. Percussion On the upper part of the manubrium looking for retrosternal goiter

13. Auscultation Looking for bruit over each thyroid lobe

14. General examination Local examination

15. General inspection body built Eyes & Face Hands Arms & Legs

24. body built Thin Obese

25. Face 1.malar flush 2.Hair loss 1.Exophthalmos 2.Lid retraction 3.Lid lag 4.Xanthelasma Eyes

26. Hands 1.Sweaty hand 2.Temperature 3.Acropachy (clubbing) 4.Onycholysis( plummer’s nails ) 5.Palmer erythema 6.vitiligo 7.Tremor 8.Pulse

27. Legs and Arms Proximal myopathy Reflexes Pretibial myxedema

28. Wail Alamoudi 0504649662

29. Identify the cricoid cartilage with the fingers of both hands. Move downward two or three tracheal rings while palpating for the isthmus. Move laterally from the midline while palpating for the lobes of the thyroid. Note the size, symmetry, and position of the lobes, as well as the presence of any nodules. The normal gland is often not palpable.