we will discuss the thyroid gland in general information technique , that mean it give you random info about the thyroid
one of the most obvious sign of thyrotoxicosis is lid retraction (upper eye lid) and exophthalmos
if you don't understood differe
nce between exophthalmos and lid retraction , so
normal eye upper lid halfway between pupil and superior limbus , lower lid at a tangent to inferior limbus
in lid retraction , lower lid normal , upper lid raised
in exophthalmos , both lids moved away from the center with sclera visible below or all round the iris
ddx of single thyroid nodule
1-may only palpable nodule of a multinodular goitre
2-cyst , caused by hemorrhage into necrotic nodule
3-benign adenoma
4-carcinoma (papillary , medullary , follicular) . the lymph nodes may be palpable , especially with papillary type
ddx of more than one lump palpable(or whole single lobe of thyroid) on thyroid exam
1-whole of one lobe , usually involved by hashimoto's thyroiditis
2-multinodular goitre
3-anaplastic carcinoma , especially if the voice is hoarse and the mass fixed to the surrounding tissue
ddx of diffuse , homogenous enlargement of whole gland
1-graves disease , primary thyrotoxicosis , slight to moderate enlargement , soft , smooth with btuit
2-hyperplastic colloid goitre , moderator to gross enlargement , bosselated , no bruit
3-thyroiditis , hashimoto's, de quervain's or riedel's , moderate or small , hard , tender
thyroid gland examination :
1-look at the eyes and neck
2-ask patient to swallow
3-feel the trachea
4-palpate the neck from behind , with the thumbs pushing head forwards to flex neck slightly
5-palpate both lobes m isthmus with fingers straight and flat
6-if one lobe is difficult to feel , make it more prominent by pressing firmly on opposite site
7-percus the lower limit of the gland listen over lateral lobes for systolic bruit
try to decide if there is :
one lump , two lump , diffuse enlargement
to differentiate thyroid-thyroglossal cyst , ask patient to protrude tongue , if mass moved , thyroglossal cyst ,(tract+hyoid bone +cyst = sistrunk operation
hypo-hyperthyroidism by history ?
hyper :
weight loss
increased appetite
heat intolerance (increase sensitivity to head)
tachycardia , palpitation ,arrhythmia
diarrhea
anxiety , nervousness , irritability , insomnia , tremors
increased hair and nail growth , increased sweating
hypo:
weight gain
decreased appetite
cold intolerance , increased sensitivity to cold
bradycardia
constipation
fatigue , depression , impaired memory , impaired concentration , mental fog
hair loss , thin nails , dry skin
