Thyroid Nick Harvey

Thyroid: Physiology

Thyroid: Differential Diagnosis Nodular Toxic Goitre >45 Nodular enlagement Toxic symptoms Eye signs? Nodular Simple Goitre 30-45 Nodular enlargement Malignant Solitary ‘cold’ nodule Papillary Follicular Medullary Anaplastic Diffuse Toxic Goitre 15-30 Diffuse enlargement Toxic symptoms Eye signs Diffuse Simple Goitre 15-30 Diffuse enlargement

Thyroid: History Onset, Course, Duration Painful or Painless Other lumps Cause Effect on General Condition Symptoms and signs of thyrotoxicosis Compression of surrounding structures Dyspnoea Dysphagia Hoarse voice

Onset, Course, Duration

Painful or Painless

Other lumps

Cause

Effect on General Condition

Symptoms and signs of thyrotoxicosis

Compression of surrounding structures

Dyspnoea

Dysphagia

Hoarse voice

Thyroid: Symptoms & Signs Nervous Nervousness, irritable, insomnia, tremors Cardiovascular Palpitations, dyspnoea, ankle swelling, AF Alimentary Increased appetite, weight loss, diarrhoea Metabolic Preference for cold weather, sweating, menstrual disturbances, impotence

Nervous

Nervousness, irritable, insomnia, tremors

Cardiovascular

Palpitations, dyspnoea, ankle swelling, AF

Alimentary

Increased appetite, weight loss, diarrhoea

Metabolic

Preference for cold weather, sweating, menstrual disturbances, impotence

Thyroid: Examination Inspection Site Size Shape Symmetry Surface Skin overlying Scars Special signs Movement with deglutition

Site

Size

Shape

Symmetry

Surface

Skin overlying

Scars

Special signs

Movement with deglutition

Thyroid: Examination Palpation Tenderness Skin temperature Size Surface Smooth, irregular Edge Well-defined, ill-defined Consistency Cystic, solid Relationship to surrounding structures Skin, muscles Draining lymph nodes Special signs Central trachea?

Tenderness

Skin temperature

Size

Surface

Smooth, irregular

Edge

Well-defined, ill-defined

Consistency

Cystic, solid

Relationship to surrounding structures

Skin, muscles

Draining lymph nodes

Special signs

Central trachea?

Thyroid: Examination Percussion & Auscultation Percuss Retrosternal goitre? Auscultation Bruit?

Percuss

Retrosternal goitre?

Auscultation

Bruit?

Thyroid: Examination Eye Signs Lid retraction Lid lag Exophthalmos

Lid retraction

Lid lag

Exophthalmos