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EXAMINATION OF
THYROID GLAND
Friday, August 25 GELETA B(MD)
, 2023
INTRODUCTION
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Thyroid gland is present in the neck enclosed by
pretracheal fascia
It has right and left lobes attached by isthmus
infront of 2nd ,3nd ,and 4th tracheal rings
The normal thyroid gland weighs approximately 20
g, but gland weight varies with body weight and
iodine intake
A projection from the isthmus usually on the left
side is called pyramidal lobe(present in 50%)
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Diseases of the thyriod usually result in
enlargement of the gland
Goals
Benign versus malignant
Toxic versus non toxic
Causes of symptoms and signs
Local effect
Systemic effect
Friday, August 25, 2023
Local effects
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Lump
Mostly slow growing and painless
Fast growth signals hemorrhage, carcinoma or
thyroiditis
Dyspnea
Tracheal infiltration by carcinoma
Retrosternal goiter
Tracheomalacia
Thyrocardiac disease
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Pain
Throiditis
Anaplastic carcinoma
Hoarseness of voice
Carcinoma infiltrating recurrent laryngeal nerve
Dysphagia
Relatively uncommon
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Systemic effects
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CNS symptoms_
tremor of hands,insomnia,sweating
Heat intolerance??, nerveousness,irritability
CVS symptoms
Palpitation, dysnea on exertion
Tachycardia,chest pain
Ankel swelling
Eye manifestations
Exophthalmos, double vision, chemosis
Friday, August 25, 2023
Physical examination
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General appearance
Active or slow
Thin or fat
Clothing
Vital signs
PR
Hair
Texture, loss
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Eyes
Lid lag, lid retraction,
Exophthalmos
Chemosis
Caused by
infiltration of the retrobulbar tissues with fluid and
inflammatory cells,
Spasm of levator palpebrae superioris
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Figure _eye signs
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Friday, August 25, 2023
Thyroid gland
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Inspection
Size, site, shape
Surface, skin appearance,boarders
Upward movement on swallowing/protrusion of tongue
Neck vein distension _pumberton sign
Position of trachea
Palpation
Stand at the front or back of patient
One side at a time,use palmar side of fingers
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Note the ff
Size,surface,tenderness,consiitency
Local temprature, tracheal position
Presence of lyphadenopathy
Percussion
For retrosternal extension
Auscultation
bruit,
Berry’s sign_absent carotid pulse
Kocker’s test_accentuated stridor
Friday, August 25, 2023
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EXAMINATION OF THE
BREAST
Friday, August 25
, 2023
Introduction
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The female breast lies against the anterior thoracic
wall, extending from the 2nd rib down to the 6th rib,
and from the sternum across to the midaxillary line
The breast is hormonally sensitive tissue, responsive to
the changes of monthly cycling and aging
Fibrous connective tissue provides structural support
in the form of fibrous bands or suspensory ligaments
connected to both the skin and the underlying fascia
To describe clinical findings, the breast is often divided
into four quadrants based on horizontal and vertical
lines crossing at the nipple
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Common or Concerning Symptoms
Breast lump or mass
Breast pain or discomfort
Nipple discharge
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Breast examination
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Timing
Best if done 5-7 days after start of menses
Inspection
patient in the sitting position and disrobed to the
waist
in four views—
arms at sides
arms over head
arms pressed against hips, and
leaning forward
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Note the ff
Skin changes_color, thickening,unusually prominent
pores
Symmetry
Contours
Dimpling
Retraction
Nipple and areola; size and shape, direction in which
they point, any rashes or ulceration, or any discharge
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Palpation
The patient should be supine with ipsilateral arm above
head
Use the flat of hand and the pad of the middle three
fingers
Follow a certain pattern and feel the entire breast
including the axillary tail
Palpate local LNs
Note the ff
Consistency, tenderness, nipple discharge
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Assess and describe the characteristics of any
nodule:
Location—by quadrant or clock, with centimeters from
the nipple
Size—in centimeters
Shape—round or cystic, disclike, or irregular in contour
Consistency—soft, firm, or hard
Delimitation—well circumscribed or not
Tenderness
Mobility _tethering and fixation
Friday, August 25, 2023
