Thyroid Examination Lecture Notes

Introduction

• Presenter: Dr. Talha
• Focus: Thyroid examination
• Preparation:
  • Wash hands
  • Introduce self to patient
  • Ensure environment is private, safe, and comfortable
  • Patient should be in a sitting position
  • Ask for patient's permission

Examination Preparation

• Exposure: Ensure face, neck, and upper chest are exposed
• Position: Stand on the right side of the patient

Inspection

• Look for:
  • Generalized or localized swelling in the thyroid area
  • Scars
  • Dilated veins
  • Redness
• Swallow Test:
  • Ask patient to swallow water
  • Assess movement of the thyroid gland (to rule out thyroglossal cysts)

Palpation

• Preparation: Inform patient before touching
• Technique:
  • Move behind the patient
  • Place thumbs behind the neck, fingers around the thyroid gland
  • Palpate both right and left lobes and the isthmus
• Considerations:
  • Ensure muscle relaxation by retracting sternocleidomastoid muscle
  • Repeat while patient drinks water
• Normal Findings: Thyroid gland is not palpable
• If Mass Palpated:
  • Comment on size, shape, consistency, tenderness/pain, mobility, and presence of thrill (audible murmur)

Percussion

• Purpose: Check for thyroid enlargement
• Technique:
  • Percuss along the manubrium sternum
  • Look for dull notes (normal is resonant)

Auscultation

• Warm stethoscope
• Place on lobes of thyroid gland
• Listen for murmurs or additional sounds indicating pathology

Special Test: Pemberton's Sign

• Purpose: Assess for congestion
• Technique:
  • Ask patient to raise arms above head for one minute
  • Check for facial congestion, cyanosis, or respiratory discomfort

Lymph Node Examination

• Conducted mostly from behind the patient, except supraclavicular nodes:
  • Submental Nodes: Below the chin
  • Submandibular Nodes: Below the jaw
  • Jugular Chain: Anterior to sternocleidomastoid muscle
  • Posterior Triangle Nodes: Posterior to sternocleidomastoid muscle
  • Occipital Nodes: Occipital region
  • Posterior Auricular Nodes: Behind the ear
  • Preauricular Nodes: In front of the ear
  • Supraclavicular Nodes: Palpated in front of the patient, ask patient to shrug shoulders
• Normal Findings: Lymph nodes are not palpable

Conclusion

• Thank the patient
• Help cover the patient
• Wash hands
• Examination concluded