approach to thyroid diseases
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8/2/2019 Approach to Thyroid Diseases
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APPROACH TO THYROID DISEASES
Basically how the approach would be depends on the way patients present.
Common presentation is in the form of anterior neck swelling - GOITRE
#What is the definition of goitre?
It means any swelling of the thyroid and does not imply any particular pathological change.
#Now a patient presents with a goitre!
Few questions need to be answered.
Is it a diffuse giotre?
Is it a multinodular goitre?
*If multinodular ± check for any evidence of a dominant nodule which might suggest malignancy.
OR Is it a solitary nodule?
Is there any retrosternal extension of the goitre?
What about presence of enlarged neck nodes
Any sudden rapid enlargement of the goitre?
Any significant voice change recently?
Any difficulty in breathing noted?
Any problem in swallowing?
Any associated pain reported?
Another question that need to be answered is;
Whether patient is Euthyroid? Or Hyperthyroid? Or Hypothyroid?
8/2/2019 Approach to Thyroid Diseases
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8/2/2019 Approach to Thyroid Diseases
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3) Biopsy
Histological studies confirm the actual diagnosis of the disease
FNAC ± quite helpful but not always correct
Core biopsy ± not advisable due to complications
Histopathological diagnosis ( paraffin section ) is the most reliable
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Notes:
Goitre is a clinical diagnosis
All goitres need pathological diagnosis
The most practical imaging investigation is USS
The definitive investigation of a solitary thyroid nodule is FNAC
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Thyroid Examination - IPPA
Inspection;
To ascertain that the swelling is a thyroid ± it should move upward when the patient
swallows. It is also important to observe the patient in general , whether he/she look restless, could
not stay still, anxious , talkative, wearing thick or thin see through clothings.
Is the patient thin or fat?
Observe while swallowing
Palpation:
Palpate the lower border while swallowing
Feel for the trachea
Palpate the gland (from behind)
Palpate the cervical lymph nodes
Anterior and posterior triangle
Percussion:
Percuss the sternal region to check for any clinical evidence of retrosternal extension
Auscultate:
Palpate for the carotid pulses
Listen to carotid bruit, thyroid bruit
Examine the hands for tremors , sweating
Check the pulse rate ± is it tachycardic?
Look for the eye signs of Thyrotoxicosis
1) Lid lag
2) Lid retraction
3) Exophthalmos
!!A Normal Thyroid Gland is non-palapable!!
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