Examination of the thyroid gland, an endocrine approach. Show
Examination of the thyroid gland. Illustration of the optimal position of the palms and use of the 2nd, 3rd and 4th digits in palpating the thyroid gland in the low anterior neck. Our approach involves sequentially inspecting, palpating, percussing (where relevant), and auscultating the thyroid. Inspection of the thyroid gland
Palpation
Percussion
Auscultation
Thyroid Gland Physical Examination SignsHashimoto’s DiseaseQueen-Anne’s sign This eponymous medical sign is named after Anne of Denmark, due to her truncated lateral eyebrows, which was depicted in a portrait by Paul Van Somer. Facial and body hair tends to be dry, thin, and brittle in hypothyroidism. Loss of hair over the lateral third of the eyebrow is a recognized sign of hypothyroidism. BradycardiaHypothyroidism is a known cause of bradycardia and significant bradyarrhythmias such as high grade atrioventricular (AV) block. A recent retrospective study involving 668 subjects, reported the need for permanent pacemaker insertions in some patients who presented with high-grade AV block, even after resolution of hypothyroidism. Pericardial and pleural effusionsThe incidence of pericardial effusions ranges between 3-6%, in mainly advanced stages of hypothyroidism. Pericardial effusions in mild hypothyroidism are, however, rare. Pleural effusion can be diagnosed by eliciting a “stony dull” percussion note and reduced tactile vocal fremitus over the lung zones. Distant heart sounds, hypotension pulsus paradoxus, and jugular venous distension may be observed in significant pericardial effusions. Dry skinDry skin (xerosis) is a cardinal skin manifestation of hypothyroidism. Xerosis is the most frequent cutaneous manifestation of hypothyroidism, with a prevalence greater than 65%. In a small study designed to assess the predictive value of the physical examination in suggesting a diagnosis of hypothyroidism, rough, dry skin had a reported positive likelihood ratio (+LR) of +2.3 in diagnosing hypothyroidism. Other cutaneous changes seen in clinically significant hypothyroidism include lymphedema and myxedema. Table 1. Other skin manifestations of hypothyroidism LesionPathophysiologyLymphedema (hands, face, and eyelids)Accumulation of hydrophilic mucopolysaccharides in the interstitial space impairs lymphatic drainageMyxedemaDeposition of mucopolysaccharides in the skin
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