– Thyroid Physical Exam –
- WIPE, blah blah 🙂
- “Take vital signs”
- Position: sitting
- Proper exposure: of the neck
- General inspection of the pt:
- Appearance: lethargic \ restless
- Body built: Over \ under wt
- Clothing: over \ under dressed
- Voice: hoarseness
- Hands\arms:
- Hands: temperature, dry\sweaty, muscle wasting, palmar erythema
- Nails: oncholysis, acropachy
- Fine tremor
- Pulse: rate\rhythm, collapsing pulse
- “Measure BP”
- Proximal myopathy
- Pemberton sign
- Head\face:
- Hair: loss\thin hair, loss of outer 1\3 of eyebrow
- Facial puffiness
- Eyes:
- Periorbital edema, thyroid stare\exophthalmos
- Conjunctiva: redness\inflamed (chemosis)
- Lid retraction (sclera visible above iris)
- Lid lag (+ do “H” formation + ask about diplopia)
- Neck:
- Inspection: obvious masses, scars, skin changes
- Swallow test + ask pt to stick their tongue out
- Palpate: thyroid, LN, trachea
- Auscultate: over each lobe for bruit
- Legs:
- Proximal myopathy
- Pretibial myxedema
- Reflexes
– Differential Diagnosis of Neck Nodule –
- Thyroid
- Thyroglossal duct cyst
- Branchial cyst
- Sebaceous cyst
- Dermoid cyst
- Lymphoma
- Lymphadenopathy
– Investigations –
– Management –
- Based on FNA results -> Bethesda system:
- Non-diagnostic -> repeat FNA + US
- Benign -> F\U w\ periodic US
- Atypia of undetermined significance -> repeat FNA in 3 months
- Suspicious for follicular\Hurthle cell neoplasm -> either total or hemi thyroidectomy
- Suspicious for malignancy (usually papillary ca) -> total thyroidectomy
- Malignant -> total thyroidectomy
– Complications of Thyroidectomy –
- Recurrent laryngeal nerve injury
- Hypoparathyroidism
- Hypothyroidism
- Bleeding\hematoma (compressing airway)
- Infection
– Types of Malignant Thyroid Cancers –
- Papillary (most common type)
- Follicular
- Medullary (associated with MEN syndromes)
- Anaplastic (worst prognosis)
– Thyroid Blood Supply –
- Superior thyroid artery -> external carotid artery
- Inferior thyroid artery -> thyrocervical trunk
- Thyroid ima artery -> aorta (variant)