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					      THYROID GLAND

History Taking & Physical Examination

Prepared By: Dr. Farees Anjum, M.D., MRCP – UK
        Asst. Consultant Diabetes Center
        King Fahad Medical City, Riyadh




                                                 1
            THYROID GLAND
              Introduction

   Body’s largest endocrine organ
   Has two lobes joined by isthmus
   Right lobe is larger than the left
   Moves upward on swallowing




                                         2
THYROID GLAND
  ANATOMY




                3
         THYROID GLAND
            Functions

   Secretes L-teraidothyronineT4
             L-tri-iodothyronine T3
   TSH – an pituitary hormone controls he
    secretion of LT4 & LT3
   TRH-Thyrotropin releasing hormone is
    secreted by Hypothalamus which controls
    synthesis and release of TSH

                                              4
             THYROID AXIS

T3, T4 (-)
                       Hypothalamus
             TRH (+)
                       Pituitary
                                   T3, T4 (-)
             TSH (+)
                       Thyroid


                                                5
             THYROID GLAND
    Physiologic Effects of Thyroid Hormone

   Promotes normal fetal and childhood growth and
    development
   Increases basal metabolic rate and heat production
   CVS: Positive Ionotropic and chronotropic actions
   GIT: Promotes gut motility
   Haemopoitic system: Increases erythropoietin secretion and
    erythropoisis
   Carbohydrate & Lipi Metabolism
   Skeletal effects: Stimulate bone turnover and bone
    resorption

                                                                 6
            THYROID GLAND
               Disorders

   Thyroid enlargement – diffuse or nodular
   Hypothyroidism
   Hyperthyroidism
   Simple Goiter
   Thyroid Malignancies



                                               7
                   THYROID GLAND
             History Taking- Hypothyroidism
   Onset: Usually Gradual
   ± Goiter
   Constitutional Symptoms:
      Cold Intolerance

      Fatigue, Lethargy

      Hoarseness

   Integument:
      Thickened/yellowed, Dry, Non-pitting Edema (Myxedema)
       of hands/feet/periorbital region, Cool,  Perspiration,
       Alopecia.
   Cardiovascular:
       contractility,  rate,  cardiac output, pericardial/pleural
       effusions,  peripheral vascular resistance. CHF rare.         8
                  THYROID GLAND
            History Taking- Hypothyroidism
   Gastrointestinal:
       Appetite, Constipation, Weight Gain (5-10% increase)

   Gynecologic:
      Menorrhagia, Menstrual Irregularities

   Musculoskeletal:
      Myalgias, Arthralgias

   Hematologic:
      Anemia

   Neurologic:
      Delayed relaxation phase of DTRs, Difficulty
       Concentrating, Poor Memory, Somnolence, Depression,
       Headache, Paresthesia
                                                                9
                 THYROID GLAND
           History Taking- Hyperthyroidism
   Goiter
   Anxiety & Irritability
   Nervousness
   Insomnia
   Excessive sweating
   Heat intolerance
   Weight loss despite good appetite
   Increase gut motility
   Palpitations
   Symptoms of Heart failure
   Tremor
   Proximal myopathy
   Eye symptoms:       - Prominence of Eyes
                        - Diplopia
                        - Decreased visual acuity   10
                    THYROID GLAND
                      History Taking
   Irregular Menses
   Pressure symptoms:         - Dysphagia
                               - Voice hoarseness
   Exposure to ionizing radiation in childhood
   Drugs:      - Amiodarone
                - IV Contrast agent
                - Lithium
   Family history of Thyroid disease
   History of other autoimmune diseases like:
    - Diabetes
    - Rheumatoid arthritis
    - Vitiligo
    - Pernicious anaemia
                                                    11
             THYROID GLAND
             Physical Examination




   Examination of Thyroid Gland
   General Examination




                                    12
                 THYROID GLAND
             Examination of Thyroid Gland

   Inspection - Thyroid enlargement
               - Moves with swallowing
   Palpation - Examine from behind using three fingers
               - Size, Shape, Consistency
               - Diffuse / Nodular
               - Confirm movement with swallowing




                                                          13
               THYROID GLAND
           Examination of Thyroid Gland


   Enlarged Thyroid Gland is called Goiter
   Generalized enlargement is Diffuse Goiter
   Irregular lumpy enlargement is called Nodular
   Palpate for Lymph Nodes



                                                14
GOITRE




         15
GOITRE




         16
               THYROID GLAND
           Examination of Thyroid Gland


   Percussion   - Sub-sternal extension
   Auscultation - For any bruits




                                           17
                THYROID GLAND
        General Examination - Hypothyroidism

   Overweight
   Myxedematous facies
   Skin is Rough, Dry and Coarse
   Generalized non pitting edema
   Voice is hoarse and croaking
   Thinning of hair
   Loss of outer third of eyebrows
   Pulse is slow
   Relaxation phase of the ankle jerk is delayed


                                                    18
THYROID GLAND
  Myxedema




                19
THYROID GLAND
  Myxedema




                20
                THYROID GLAND
       General Examination - Hyperthyroidism
   Thin / Low BMI
   Anxious, Fidgety & Restless
   Sweaty Palms
   Clubbing – Thyroid acropachy
   Fine tremor of outstretched hands
   Tachycardia
   Proximal myopathy
   Hyperactive reflexes
   Ocular signs:       - Exoptholmos
                        - Lid lag
                        - Lid retraction
   Pretibial myxedema
                                               21
PTRETIBIAL MYXEDEMA




                      22
PRE-TIBIAL MYXEDEMA




                      23
THYROID GLAND
  Exoptholmos




                24
THYROID GLAND
  Exoptholmos




                25
THYROID GLAND
  Exoptholmos




                26
THYROID GLAND
   Eye Signs




                27
THYROID GLAND




                28
    THYROID GLAND
Onycholysis of Thyrotoxicosis




                                29
SUMMARY




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Thank You   32

				
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posted:8/1/2012
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