The lost Art of Physical Examination of the Thyroid and Endocrine Neck

The lost Art of Physical Examination of the Thyroid and Endocrine Neck

The lost Art of Physical Examination of the Thyroid and  Endocrine Neck

The lost Art of Physical Examination of the Thyroid and Endocrine Neck

  1. Modern imaging and Thyroid function tests have resulted in few physicians in 2017 learn the proper way to examine a neck.
  2. Interview patient: Hoarsness, tracheal deviation, inspirational stridor, swallowing complaints, 3 D’s Dysphonia,dysphagia, dyspnea.
  3. Inspect the neck: scars, asymmetry, and masses. Lying down gives the best view of the neck and moves the thyroid gland up from a low neck position.
  4. Redness over a tender swelling + acute thyroiditis, infected thyroglossal duct or brancial cleft cyst.
  5.  Looking at the neck is a valuable tool to find thyroid disease. When swallowing the thyroid moves up 1.5 to 3.5 cm before moving back down.
  6. Pseudogoiter is seen in thin patients when the thyroid sits high in the neck.the gland is not enlarged and is normal.
  7. Long curved necks with cervical spine lordosis can have an illusion of a goiter. Painter Modigliani syndrome painted subjects with this illusion.
  8. Midline masses may be thyroglossal duct cysts which move up with extension of the tongue.
  9. Big goiters below the sternal notch can cause outlet obstruction and a vein extensions over the neck area. Pemberton’s sign.
  10. A normal thyroid is rarely palpated.
  11. A thrill can be felt and bruit heard over a thyrotoxic goiter.
  12. Palpation of the thyroid can cause temporary increase in T4, T3 and TG but not TSH.
  13. Extended palpation by several observers can cause palpation thyroiditis.
  14. Pain in the thyroid may indicate thyroiditis. Subacute thyroiditis has pain and tenderness. Rarely Hashimoto’s thyroiditis has pain. Acute pain is associated with a hemorrhage with a nodule. Cancer rarely has pain at onset.
  15. Neck lymph nodes and parathyroid cysts may be large enough to feel. Most are only found on ultrasound neck studies
  16. No just look at the ultrasound or blood studies. Take time to look and feel the neck structures.

 

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