thyroid history taking

Patients with hypothyroidism may have changes such as mental dullness (even coma), hearing loss, and decreased tendon reflexes. Having an enlarged thyroid gland or a goiter. It may be best to examine one side at a time here. Change ), You are commenting using your Facebook account. Consider fluctuation and transillumination. Paracelsus in … Inspect for evidence of inflammation affecting the eyes. Graves’ disease. The examiner has an excellent feel of the anterior surface of the […], […] and contribute to loss of appetite or decreased lean body mass. Inspection of the neck was unremarkable but palpation revealed a mass in the thyroid region that contained multiple nodules. Patient History: Thyroid Risk Factors. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. You may be given a history of a hyperthyroid or hypothyroid patient, or you may be asked to examine the patient’s neck or thyroid gland. In neck swellings, one should percuss the upper sternum for a possible retrosternal extension of the goiter. Thyroid acropachy and pretibial myxoedema. Auscultation of the thyroid gland did not reveal any bruits, reflexes were normal and there was no evidence of pretibial myxoedema or proximal myopathy.”, “In summary, these findings are consistent with a toxic multinodular goitre.”, “For completeness, I would like to perform the following further assessments and investigations.”. Observe for restriction of eye movements and ask the patient to report any double vision or pain. 7. If a mass is identified during the initial inspection, perform some further assessments to try and narrow the differential diagnosis. 5. Xanthomas, cool and dry palms, and cyanosis suggest hypothyroidism. 6. 3. Proximal myopathy is a potential complication of both multinodular goitre and Graves’ disease. The most common cause of thyrotoxicosis is Over the past month you have Changes in TSH can serve as an “early warning system” – often occurring before the actual level of thyroid hormones in the body becomes too high or too low. To assess for evidence of a subtle peripheral tremor: 1. A common mistake is a “piano-playing” or “spider’s legs” technique with the fingertips over the skin rather than correctly using the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue. Ask the patient to sit on a chair for the assessment. Thyrotoxicosis is much commoner in females than in males; Thyroid carcinomas occur three times more often in females, Thyrotoxicosis may appear in individuals working under stress & strain, Endemic goiter due to iodine deficiency. Auscultate each lobe of the thyroid gland for a bruit using the bell of the stethoscope. Ask the patient to protrude their tongue (if a mass represents a thyroglossal cyst, you will feel it rise during tongue protrusion). Move your finger through the various axes of eye movement (“H” shape). restricted eye movement, diplopia) and pain during eye movement caused by Graves’ disease (lymphocytic infiltration of orbital fat, connective tissue and extraocular muscles): 1. Does it cause symptoms that relate to pressure effects on nearby structures? A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. The second type, a Patients with thyrotoxicosis are usually thin and underweight. These include: Pinterest Feeling slow and sluggish Tired all the time Lack of energy Feeling cold easily, especially in the hands and feet Hair falling out Weight gain Delayed reflexes Constipation Explore hypothyroidism. The tongue is attached to the thyroglossal duct, which is why thyroglossal cysts rise during tongue protrusion. The best way to initially test thyroid function is to measure the TSH level in a blood sample. Asks an open-ended question. 3. A short history of thyroid swelling should alert to the possibility of thyroid cancer and demands ultrasound and fine needle aspiration assessment, though this is not typical with thyrotoxicosis. The other systems: cardiovascular, respiratory, and others should be examined for completeness. 2. previous thyroidectomy). [Dev R. et al., 2014]. It can spot lumps or inflammation, or to investigate the cause of an overactive thyroid. Other general features of hyperthyroidism include pretibial myxedema. The most commonly tested reflexes are the biceps reflex or the knee jerk reflex (you only need to assess one). You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Thyroglossal cysts will move upwards noticeably during tongue protrusion. Numerous symptoms and signs are associated with hypothyroidism and can be related to the underlying cause, or a direct effect of having not enough thyroid hormones. 4. In: Clinical Examintion, a Systematic Guide to Physical Diagnosis. Losing weight. There was no palpable lymphadenopathy but retrosternal dullness was present to the level of the manubrium. exam your doctor may try to detect a slight tremor in your fingers when they're extended An invasive thyroid malignancy may not move with swallowing if tethered to surrounding tissue. Note the tenderness, temperature, location, size, shape, surface, margins, edges, fixity, consistency, and thrill. To screen for proximal myopathy ask the patient to stand from a sitting position with their arms crossed (to minimise their ability to mask proximal muscle weakness). Retrosternal dullness may indicate a large thyroid mass extending posteroinferiorly to the manubrium. Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue to assess the various characteristics of the lymph nodes. Any order of examination can be used, but a systematic approach will ensure no areas are missed: Take caution when examining the anterior cervical chain that you do not compromise cerebral blood flow (due to carotid artery compression). ( Log Out /  We've also just launched an OSCE Flashcard Collection which contains over 1000 cards. is it tethered to underlying tissue). A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. You should also ask them to relax their hands in their lap. To identify exophthalmos, inspect the eye from the front, the side and from above. 16. The Clark T. Sawin History Resource Center is intended to be of primary benefit to the American Thyroid Association (ATA) as it supports and memorializes the work of Dr. Clark T. Sawin, a loyal and valued member of the ATA from 1972 - 2004. Introduces himself. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Evaluate the patient for hyperthyroidism. 2. 10 ed. Patients with hypothyroidism are usually obese and overweight. Once you have located the radial pulse, assess the rate and rhythm. c. Look at the adjacent structures, especially the trachea. You can calculate the heart rate in a number of ways, including measuring for 60 seconds, measuring for 30 seconds and multiplying by 2 or measuring for 15 seconds and multiplying by 4. Drugs (some may be goitrogenic) Family history; Some thyroid disorders have a familial predilection. Talley NJ, O’Connor S. The thyroid. Either way you should approach the situation systematically and not jump straight into feeling the neck. It has a definite focus towards a patient with a thyromegaly, but it can also be considered a guide to the history and presentation of a patient with a swelling in the neck. Dietary habits are important as vegetables of the brassica family (cabbage, kale, rape) are goitrogens. Start in the submental area and progress through the various lymph node chains. Licence. 3. Any individual mass palpable within the thyroid gland. Self-induced purging may be aided by the […]. Wash your hands and don PPE if appropriate. Thyroid nodule. Due to lid retraction and exophthalmos, the eye is more prone to dryness and the development of conjunctival oedema (chemosis), conjunctivitis and in severe cases corneal ulceration. Kolkata: Somen Das; 2013. Ask about the effect of the swelling on the. The thyroid may also press on the carotid, but that will be evaluated during examination. Thyroid surgery usually takes place without problems. Thyroid is a Greek word to indicate shield shape 16. Ask the patient to keep their head still and follow your finger with their eyes. Move your fingers inferiorly until you reach the cricoid cartilage. management strategies for thyroid storm and myxedema coma states. This thyroid status examination OSCE guide provides a clear step-by-step approach to assessing thyroid status, with an included video demonstration. Exophthalmos is bulging of the eye anteriorly out of the orbit. Grapefruit on the other hand is known to increase the absorption of levothyroxine as it increases acidity in the stomach. Thyroid hormones play a vital role in removing excess cholesterol from the body … Natural Thyroid began it’s debut by the late … This field is for validation purposes and should be left unchanged. The eye signs of hyperthyroidism include exophthalmos, chemosis, conjunctival injection, corneal ulceration, opthalmoplegia, lid-lag, lid retraction, and others. Confirm the patient’s name and date of birth. Please write a single word answer in lowercase (this is an anti-spam measure). Thyroid status symptoms of hyper or hypothyroidism. Move your finger in a downwards direction whilst observing the patient’s upper eyelids as the patient’s eyes follow your finger. Licence: Bp20151130. You may also have a hoarse voice or sore throat for a few days. Hashimoto's thyroiditis may present with the mass effect of a goiter (enlarged thyroid gland). Goitre. This allows us to get in touch for more details if required. ( Log Out /  There were no objects or medical equipment around the bed of relevance.”, “The patient was tachycardic at 105 bpm with a regular pulse. Briefly explain what the examination will involve using patient-friendly language. How to take a history of swelling is described in the presentation titled “Mass, history and examination”. c. recurrent laryngeal nerve, causing hoarseness. For irregular rhythms, you should measure the pulse for a full 60 seconds to improve accuracy. Thyroid gland masses and lymph nodes will not move during tongue protrusion. Lid lag refers to a delay in the descent of the upper eyelid in relation to the eyeball when looking downward. History Clarifies location of mass (patient thinks it’s on the her right side of her neck) 2. The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of the external carotid artery, and the inferior thyroid artery, a branch of the thyrocervical trunk, and sometimes by an anatomical variant the thyroid ima artery, which has a variable origin. 4. Symptoms of an overactive thyroid (hyperthyroidism) can include: Experiencing anxiety, irritability and nervousness. Its objective is to feel the posterior part of the gland. Thyrotoxicosisis the clinical manifestation of excess thyroid hormone action at the tissue level due to inappropriately high circulating thyroid hormone concentrations. The first two rings of the trachea are located below the cricoid cartilage and the thyroid isthmus overlies this area. In a patient with a neck swelling that may be the thyroid gland, look for symptoms of hyperthyroidism and hypothyroidism, Hyperthyroidism: Heat intolerance, raised appetite, weight loss, sweating, palpitations, tiredness, agitation/nervousness, dyspnea; also diarrhea, menstrual changes (commonly amenorrhea), insomnia, Hypothyroidism: Weight gain, loss of appetite, constipation, cold intolerance, hoarseness of voice, decreased hearing, hair loss, dry skin, hand pain (carpal tunnel syndrome), angina pectoris, intellectual/ motor slowing (excessive sleeping), muscle cramps, (commonly menorrhagia), Past, treatment, family, and dietary history, Ask about treatment the patient has taken, and its effects on the swelling. Patients with hyperthyroidism may have neurological changes such as anxiety, proximal muscle weakness, and increased tendon reflexes. Both assess the health of your thyroid, a gland in your neck. This article is titled “History and examination of the thyroid gland”. Ask about eye symptoms eg protruding or staring, difficulty closing eyelid, double vision. Nodules are typically benign, may be hyperfunctioning, and may occur within a multinodular goitre, but always require assessment for possible malignancy. Dietary history; Dietary habits are important as vegetables of the brassica family (cabbage, kale, rape) are goitrogens. Ask the patient if they have any pain before proceeding with the clinical examination. A Timeline Report Historical references to what we now know as the thyroid gland arose early in medical history. Ask the patient to tilt their chin slightly downwards to relax the muscles of the neck and aid palpation of lymph nodes. […] test is done during examination of the thyroid to rule out trachea narrowing (scabbard trachea). Observe for a contraction of the biceps muscle and associated flexion of the elbow. Explain to the patient that the examination is now finished. Ask the patient to swallow some water and observe the movement of the mass: Ask the patient to protrude their tongue: Palpate each of the thyroid’s lobes and the isthmus: 1. An inability to stand up would suggest proximal muscle weakness. Wash handsIntroduce yourselfConfirm patient details – name / DOBExplain the If there is insufficient iodine in the diet, an iodine-deficiency goiter may develop. Cretinism & thyroid gland

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