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BISMILLAHIRRAHMANIRRAHIM
PHYSICAL
EXAMINATION OF
THYROID DISEASE
SITI ANNISA DEVI TRUSDA
INTRODUCTION
• Once diabetes is excluded, thyroid disease
constitute the main bulk of endocrine
problems have to sort out during the clinical
practice.
Presents with :
• Excessive hormonal activity  hyperthyroidism
• Under production of the hormone
hypothyroidism
• CC: swelling of the neck
Anatomy of Thyroid Gland
Anatomy of Thyroid Gland
Physical Examination
• Assess the patient’s level of consciousness,
blood pressure, pulse rate, respiration,
temperature, height, body weight and BMI
• Assess the Face and Eyes examination :
Lid retraction,
Periorbital edema,
Exophthalmos,
Puffy face,
Hoarse, husky voice
Exophthalmos
Assess the thyroid and pretracheal
lymph nodes examination
Examination of thyroid gland :
• Observe the neck, especially as the
patient swallows
Diffuse Goiter
Unilateral Swelling
Examine from front of patient :
• to palpate the right lobe : palpate with
your left thumb while fixating the left lobe
with your right thumb
• rotate the gland slightly with one thumb
while palpating the other lobe with the
other thumb
• same principle for the other lobe
Palpation from the front
Examine from behind the patient :
• ask the patient to flex the neck slightly
forward to relax the sternocleidomastoid
muscles
• place the three fingers of both hands on
the patient’s neck so that your index
fingers are just below the cricoid cartilage
• ask the patient to sip and swallow water as
before. Feel for thyroid isthmus rising up
under your finger pads
Palpation from behind
• displace the trachea to the right with fingers
of left hand, palpate lateral part of right lobe
thyroid gland with the fingers of the right
hand,
• palpate in the space between the displaced
trachea and the relaxed sternocleidomastoid
muscle, find the lateral margin.
• In similar fashion, examine the left lobe. The
lobes are somewhat harder to feel than the
isthmus
• if the thyroid is enlarged, auscultation for
listen bruit by placing bell stethoscope above
the lateral part of thyroid gland
• The size of thyroid nodules can be measured
by first drawing and outline on the skin
Assess the cardiac condition :
• Bradycardia and tachycardia
Assess the pulmonal condition :
• Slow respiration, shortness of breath
• Assess the abdominal condition : slowed
or rapid peristaltic
• Assess the extremitas condition :
• Tremor
• Thyroid dermopathy
• Moist hand, warm
• Dry skin
• Myxedema
Dermopathy
Assess the neuromuscular system
• Slow reflexes
• Hyper reflexes
Assess the musculoskeletal system
• Muscular weakness
LID RETRACTION
LID RETRACTION