clinical diagnosis of thyroid disorders
TRANSCRIPT
Clinical Diagnosis of
Thyroid Disorders
Reynaldo O. Joson, MD1985;2001
Thyroid Disorders
Very common
in the
Philippines!
Clinical Diagnosis of
Thyroid Disorders
Reynaldo O. Joson, MD1985;2001
Clinical Diagnosis
Diagnosis based on
•History
•Physical Exam
Learning Objectives
•Proper utilization of methods of clinical evaluation
•Identification of patients with and without thyroid disorders
•Nomenclature of thyroid disorders
•Clinical classification of goiter
•Physical signs of thyroid cancer
Proper utilization of methods of clinical
evaluation
Clinical Diagnosis
Diagnosis based on
•History
•Physical Exam
Clinical Diagnosis
Thyroid Patients
Physical exam
more important than
history!
Clinical Diagnosis
Physical exam data
more reliable than
historical data!
Physical Examof
Thyroid Patients
Thyroid Patients Physical Exam•Inspection of neck
•Palpation of paratracheal area
•Palpation of lateral neck
•Pulse rate
•Looking for
•Exophthalmos
•Hoarseness of voice
•Distant mass
Low paratracheal mass that moves with deglutition
suspect thyroid
pathology!
Pulse Rate and Goiter
Less than 90/min
- nontoxic goiter
90/min and above
- to rule out toxic goiter
Hyperthyroidism Present
(+) Signs of hyperthyroidism
•Goiter
•Tachycardia
•Exophthalmos
•Bruit
•Tremor
Hypothyroidism Present
(+) Signs of hypothyroidism
•Goiter
•Dwarfism
•Slow body movements
Identification of Patients With and Without Thyroid Disorders
Thyroid Disorder Present
If thyroid gland has nodule or nodules
Thyroid Disorder Present
If thyroid gland is abnormally enlarged
Thyroid Disorder Present
(+) regional or distant mass considered metastatic from
occult thyroid cancer
Thyroid Gland
•Normally NOT palpable
•Palpable yet normal
•very thin patients
•physiologic enlargement
Thyroid Disorder NOT Present
• Gland is NOT palpable
•PR less than 90/min
•NO metastatic mass
Nomenclature of
Thyroid Disorders
When making a diagnosis,
know the name of the disease!
Colloid Adenomatous Goiter
• Diffuse colloid adenomatous goiter• Colloid cyst• Colloid adenomatous nodule• Multiple colloid adenomatous goiter
•Hyperthyroidism
•Hypothyroidism
Thyroid Cancer
• Papillary Cancer• Follicular Cancer• Medullary Cancer• Anaplastic Cancer
Thyroiditis
• Acute thyroiditis• Thyroid abscess• Chronic thyroiditis
Follicular AdenomaClinical Diagnosis
Follicular adenoma
vs follicular carcinoma
vs colloid adenomatous nodule
Clinical Classificationof
Goiters
Clinical Classification
• Diffuse toxic goiter• Diffuse nontoxic goiter• Nodular toxic goiter• Nodular nontoxic goiter
Diffuse Goiter
All lobes almost symmetrically enlarged
with NO nodule(s)
Diffuse GoiterNormal size thyroid gland
Clinical ClassificationNOT the same as
Clinical Diagnosis!
Diffuse Toxic GoiterHyperthyroidism
Diffuse Nontoxic GoiterDiffuse Colloid Goiter
Uninodular Toxic GoiterHyperthyroidism
Multinodular Toxic GoiterHyperthyroidism
Uninodular Nontoxic Goiter
Colloid cystColloid adenomatous nodule
Thyroid cancerChronic thyroiditis
Multinodular Nontoxic Goiter
Multiple Colloid adenomatous nodule
Thyroid cancerChronic thyroiditis
Nodular goitersNormal size thyroid gland
Diffuse goiterNormal size thyroid gland
Nodular goiter
Nodular Goiter
If one lobe is smoothly enlarged, the other lobe
is normal.
Physical Signs of
Thyroid Cancer
Suspect Malignancy
Nodular goitersSolid noduleFixed nodule
Suspect MalignancyLocal invasion
HoarsenessDysphagiaDyspnea
Skin infiltrationRegional spread
Distant metastasis
Clinical Diagnosisof
Thyroid Disorders
Diagnostic Process
• Proper methods of clinical evaluation• Identification of patients with or without
thyroid disorder• Nomenclature of thyroid disorders• Clinical classification of thyroid
disorders• Physical signs of thyroid cancer
Thyroid gland
NOT palpable
NO nodule
PR < 90/min
No cancer signs (elsewhere)
Thyroid gland
NOT palpable
NO nodule
PR < 90/min
No cancer signs (elsewhere)
Normal thyroid gland
Thyroid gland
Diffusely slightly enlarged
PR < 90/min
Adolescent/perinatal
Thyroid gland
Diffusely slightly enlarged
PR < 90/min
Adolescent/perinatal
Physiologic goiter
Diffuse goiter
PR > 90/min
No cancer signs
Diffuse goiter
PR > 90/min
No cancer signs
To rule out hyperthyroidism
Diffuse goiter
PR > 90/min
No cancer signs
Exophthalmos
Diffuse goiter
PR > 90/min
No cancer signs
Exophthalmos
Hyperthyroidism
Diffuse goiter
PR < 90/min
No cancer signs
Diffuse goiter
PR < 90/min
No cancer signs
Diffuse colloid adenomatous goiter
Solitary nodule, NOT hard
PR > 90/min
No cancer signs
Solitary nodule, NOT hard
PR > 90/min
No cancer signs
To rule out hyperthyroidism
Solitary nodule, cystic
PR < 90/min
No cancer signs
Solitary nodule, cystic
PR < 90/min
No cancer signs
Colloid cyst
Solitary nodule, hard solid
PR < 90/min
Solitary nodule, hard solid
PR < 90/min
Thyroid cancer
Solitary nodule, NOT hard solid
PR < 90/min
LYTIC skull mass
NO dysphagia
NO dyspnea
Solitary nodule, NOT hard solid
PR < 90/min
LYTIC skull mass
NO dysphagia
NO dyspnea
Follicular cancer with skull metastasis
Solitary nodule, NOT hard solid
PR < 90/min
Ipsilateral neck nodes
NO dysphagia
NO dyspnea
Solitary nodule, NOT hard solid
PR < 90/min
Ipsilateral neck nodes
NO dysphagia
NO dyspnea
Papillary thyroid cancer with neck node metastasis
Huge thyroid nodule, fixed
PR < 90/min
(+) dysphagia
(+) dyspnea
Huge thyroid nodule, fixed
PR < 90/min
(+) dysphagia
(+) dyspnea
Anaplastic Carcinoma
Multiple nodules
PR < 90/min
No cancer signs
Multiple nodules
PR < 90/min
No cancer signs
Multiple colloid adenomatous goiter
Multiple nodules
PR > 90/min
No cancer signs
Multiple nodules
PR > 90/min
No cancer signs
To rule out hyperthyroidism
Nodular gland
NO discrete mass
PR < 90/min
No cancer signs
Nodular gland
NO discrete mass
PR < 90/min
No cancer signs
Chronic thyroiditis
Tender fluctuant mass, thyroid
PR > 90/min
No cancer signs
Tender fluctuant mass, thyroid
PR > 90/min
No cancer signs
Thyroid abscess
Diffuse goiter
PR < 90/min
No cancer signs
Short obese stature
Slow body movements
Diffuse goiter
PR < 90/min
No cancer signs
Short obese stature
Slow body movements
Hypothyroidism
Diffuse goiter
PR < 90/min
No cancer signs
Slow body movements
Diffuse goiter
PR < 90/min
No cancer signs
Slow body movements
Hypothyroidism
Diffuse goiter
toxic goiter common
Nodular goiter
toxic goiter rare