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Thyroid.pptx
- 1.
- 2. History • Name • Age •Occupation • Address
- 3. Presenting Complaints • Swellingin front of neck • Pain • Hoarseness • Difficulty in swallowing/breathing • Tremor • Weakness • palpitation
- 4. History Of PresentingIllness • Swelling • Duration, onset, progression • Swelling whether single or multiple
- 5. • Pain • Durationonset progression • Character of pain
- 6. • Pressure symptoms •Dysphagia • Dyspnoea • Stridor • Hoarseness • Horners syndrome
- 7. • Features ofToxicity • Hyperthyroidism • Loss of weight inspite of good appetite • Diarrhoea • Chest pain • palpitation • Heat intolerance • Amenorrhea • Irritability, nervousness, tremors • Proximal muscle weakness
- 8. • Features ofhypothyroidism • Lethargy, weight gain, poor appetite • Cold Intolerance • Menorrhagia constipation • Loss of hair • Dry skin
- 9. Past History • Irradiationfor benign conditions – papillary carcinoma • Thyroglossal cyst-infected-fistula • Previous surgery •
- 10. Personal history • Smokingalcohol • Drugs which can alter thyroid function • Dietary habits- brassica family vegetables • Iodized salt
- 11. • Family hisory •Menstrual history • Treatment history
- 12. General examination • Tobe followed as in other cases • Level of consciousness orientation • P I C C L E • Pulse Rate( atrial fibrillation, sleeping PR) • BP
- 13. Specific for thyroidexamination • Face of the patient • Is the patient anxious or worried- hyperthyroidism • Dull lethargic expressionless – hypothyroidism • Look for eye signs- lid retraction, exophthalmos, ophthalmoplegia, chemosis
- 14. Exophthalmos • Von Graefessign • Joffroys sign • Stellwags sign • Moebius sign • Dalrymples sign
- 15. Examination contd • Skinis wet warm in hyperthyroidism • Both legs and ankle should be inspected for pretibial myxedema • Tremor of hands and tongue
- 16. Local examination • INSPECTION •Swelling • Location, size, shape • Extend – between Sternomastoid and trachea if one lobe or between 2 sternomastoids if both lobes Upper extend is usually upto thyroid cartillage • Lower border visible or not • Movement – with deglutition with protrusion of tongue
- 17. Inspection contd • Scars •Dilated veins • Pulsations • Surface • Pemberton’s sign- retrosternal goitre
- 18. PALPATION • Swelling • Temperature •Tenderness • Extent, position, shape and exact size surface • Consistency • Margins • Plane of the swelling- deep to deep fascia deep to sternomastoid • Movement with deglutition and lower border of the gland • Thrill is checked in the upper pole of the gland
- 19. Method of palpationof thyroid gland • Gland palpated from the back while patient in sitting position with neck partially flexed • Each lobe is palpated in whole and isthmus • Assess for nodules, surface and the consistency of each lobe
- 20. • Lahey’s method •For assessing individual lobes • The lobe to be palpated is made prominent by pushing from opposite side and palpated with the palmar aspect of the hand
- 21. • Crile’s method •To appreciate the individual nodules • Palpated with the pulp of the thumb
- 22. • Pizillos method •For short necked patients and obese patients • Clasp the hands over the occiput and gland becomes prominent
- 23. • Kochers test •Test for tracheal compression • Lateral lobes are compressed against the trachea • Watch for stridor
- 24. Tests for retrosternalextension • Lower margin not visible • Lower margin not palpable on deglutition • Dilated veins on the neck and chest wall • Percussion over manubrium-dull • Pemberton’s sign positive
- 25. • Position oftrachea • Tracheal deviation is common in long standing goitres • May contribute to compression • Trail sign
- 26. • Carotid pulsation •Should be checked for its presence and normal position • Berry sign: absence of carotid pulsation in advanced carcinoma due to infitration of carotid sheath • Long standing large goitres can push the carotid away from its normal position
- 27. Palpation of regionalneck nodes • Enlarged in case of carcinoma of thyroid usually in papillary ca thyroid and lymphoma • All regions of the neck node should be examined • Carcinoma usually spreads to level2,3,4 LN
- 29. Examination of othersystems • Cardiovascular system especially in case of secondary thyrotoxicosis • Tachycardia ectopics extrasystole atrial fibrillation • Neurological system and reflexes • Respiratory system for pleural effusion in case of secondaries • Abdominal examination for hepatomegaly in case of follicular ca splenomegaly in lymphoma • Skull and spine