1. ENDOCRINE EXAMINATION: THYROID Wimpie de Lange Div. of Endocrinology Dept. of Internal Medicine October 23, 2015

2. ENDOCRINE EXAMINATION The Thyroid

3. 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

4. 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/ ]

5. 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 face Respiratory distress/ stridor Engorgement of neck veins Syncope

10. SIGNS OF HYPERTHYROIDISM Signs of weight loss Anxiety thyroid acropachy Hands: Fine tremors, onycholysis (Plummer’s nails), thyroid acropachy, palmar erythema, skin warm and clammy. Pulse: Sinus tachycardia, atrial fibrillation, hyperdynamic circulation. 2 Chest: Heart murmur 2, heart failure Pre-tibial myxoedema Legs: Pre-tibial myxoedema, Proximal muscle weakness and increased reflexes.

13. EYE SIGNS Sympathetic overactivity: staring gaze, lid retraction, lid lag Ptosis Exophthalmos Chemosis Conjunctivitis Corneal ulceration Optic atrophy Ophthalmoplegia

18. 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.