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Thyroid examination
Last reviewed: 19.10.2021
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When examining the front surface of the neck, you can find a pronounced enlargement of the thyroid (goiter), which sometimes leads to a sharp change in the configuration of the neck. In such cases, attention is paid to the symmetry of the increase in the various parts of the thyroid gland.
The main clinical method of research of the thyroid gland is its palpation.
As is known, thyroid lobes are covered in front by muscles, which complicate (in particular, the sternocleidomastoid muscle) their palpation. It is generally accepted that in healthy people (especially men) the thyroid gland is not palpable. Nevertheless, some domestic and foreign authors believe that in some cases (in women with a very thin neck), one can feel the thyroid gland in a healthy person, which in such cases is felt as a soft cushion located in the lateral surface of the thyroid cartilage. The normal sizes of the thyroid gland do not exceed 3-6 cm in the original, 3-4 cm in diameter, 1-2 cm in thickness.
There are 3 most common methods of palpation of the thyroid gland.
In the first method of palpation, the physician in front of the patient deep-winds the bent II-V fingers of both hands behind the posterior edges of the sternocleidomastoid muscles, and the thumbs in the region of the thyroid cartilages are inside the front edges of the sternocleidomastoid muscles. During palpation, the patient is asked to take a sip, as a result of which the thyroid gland moves with the larynx upward and moves under the fingers of the doctor. The isthmus of the thyroid gland is palpated on the front surface of the neck with the help of sliding finger movements in the vertical direction.
In the second method of palpation, the doctor is located on the right and slightly in front of the patient. For greater relaxation of the neck muscles, the patient slightly tilts his head forward. With his left hand, the doctor fixes the patient's neck, hugging her from behind. Palpation of the thyroid gland is performed with the fingers of the right hand, with the palpation of the right lobe being carried out with the thumb, and palpation of the left lobe with the other fingers folded together.
With the third method of palpation of the thyroid gland, the doctor becomes behind the patient. Thumbs are placed on the back of the neck, and the remaining fingers are placed on the thyroid cartilage region to the inside of the anterior edge of the sternocleidomastoid muscles. The palms of the doctor are located with this method of palpation on the lateral surfaces of the neck.
Having palpated the thyroid gland by one of these methods, determine its size, surface, consistency, the presence of nodes, mobility when swallowing, soreness.
To characterize the size of the thyroid gland, a classification is proposed that provides for the isolation of several degrees of its increase.
In those cases when the thyroid gland is not palpable, it is customary to talk about the degree of its increase. If its isthmus is clearly palpable, it is believed that there is an increase in the thyroid gland of the first degree. With an increase in grade II, the thyroid glands are palpable, and the thyroid gland itself becomes noticeable when swallowed. With an increase in grade III, the thyroid gland is clearly visible even during routine examination ("thick neck"); such a thyroid gland is already called goiter. With an increase in the thyroid gland IV grade, the normal configuration of the neck changes abruptly. Finally, under the enlargement of the thyroid gland of the V degree, we mean goiter of very large size.
With diffuse toxic goiter, the consistency of the thyroid gland can be soft or moderately dense, but its surface remains flat.
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When palpation of nodes in the thyroid gland determine their number and consistency. With adenoma of the thyroid gland, it is often possible to palpate a knot of a densely elastic consistency, with clear boundaries and a smooth surface, mobile and uncoated with surrounding tissues. With a cancerous lesion of the thyroid gland, the palpable knot becomes dense (sometimes stony), loses uniformity of contours and mobility when swallowed. Soreness in palpation of the thyroid gland is observed with its inflammatory changes (thyroiditis).
After the palpation, the neck circumference is measured at the level of the thyroid gland. In this case, behind the centimeter band is set at the level of the spinous process of the VII cervical vertebra, and in front - at the level of the most prominent area of the thyroid gland. When detecting individual nodes, their diameter can be measured with a special compass.
The method of percussion can be used to detect a chest ailment. In such cases, the shortening of the percussion sound is determined above the sternum arm.
When auscultation of the thyroid gland in patients with diffuse toxic goiter, it is sometimes possible to listen to functional noise caused by increased vascularization of the thyroid gland and acceleration of blood flow in this disease.
In patients with diffuse toxic goiter, so-called eye symptoms are often detected. These include, in particular, the symptom of Dalrymple (the widening of the eye slit with the exposure of the scleral band over the iris), the Stellwag symptom (a rare flashing), the Moebius symptom (weakening of convergence). To determine the symptom of Moebius, an object (a pencil, a pen) is approached to the patient's face and the patient is asked to fix a look on it. With insufficient convergence, the eyeballs of the patient involuntarily go to the sides.
The Gref symptom is the appearance of a scleral band between the upper eyelid and the iris when the eyeball moves downwards. In determining this symptom, the patient is also asked to look at the object that is being moved from top to bottom. During movement, it becomes apparent how the upper eyelid of the patient lags behind the movement of the eyeball.
The symptom of Kocher is the appearance of the same scleral band between the upper eyelid and the iris when the eyeball moves upward, i. E. Lag of the eyeball from the upper eyelid.