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Goitre (Thyroid Examination (Eyes (Graves (Exophthalmos: inspect from…
Goitre
Thyroid Examination
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Preparation
Ensure exposure down to the clavicles
Position pt. away from a wall
Are you comfortable: not too hot or cold?
Hoarse voice: recurrent laryngeal nerve palsy
General Inspection
Nervous/agitated or slow/lethargic
Body habitus
Sweaty
Skin and hair condition
Hands
Thyroid acropachy
Palmar erythema
Temperature, sweating
Fine tremor: piece of paper on out-stretched hands
Pulse: rate and rhythm (AF in thyrotoxicosis)
Neck
Inspect: from front and side.
Look for collar scars
Ask pt. stick out tongue and swallow water
Look in mouth for lingual thyroid
Palpate: from behind
Palpate masses: can you get under it?
Repeat the swallow and protrusion test
Lymphadenopathy
Check for tracheal deviation.
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Legs
Pretibial myxoedema: brown swelling above lat. malleoli
Proximal myopathy: ask pt. to stand from chair (Graves)
Ankle reflexes: kneel on chair
Slow relaxing: hypothyroidism
Brisk: hyperthyroidism
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Viva
Ix
Bloods
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Other: FBC, Ca2+, calcitonin, ESR
Antibodies: anti-TPO, TSH
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Goitre Differential
Diffuse Enlargement
Smooth
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Thyroiditis: Hashimoto’s, de Quervain’s, Riedel’s
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Solitary Nodule
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Malignant
Primary: papillary, follicular, medullary, anaplastic
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Hx
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Compression symptoms: dysphagia, difficulty breathing
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