Name: palpating the thyroid for goiter
Uploaded: 2015-03-10T16:57:07.000Z
Duration: 6 min 35 s
Channel: JoVE

K12 Standards

new-york-state-science-learning-standards

New York State Science Learning Standards

High School

Life Science

Structure and Function

HS-LS1-3.

Thyroid Exam

1. التفتيش
<ol>
	<li>اقلب رأس المريض للخلف قليلا ، وافحص بعناية الرقبة الأمامية. إذا كانت مرئية ، تظهر الغدة الدرقية بين الغضروف الحلقي والشق العلوي للخلف. تحقق من التماثل والتورم المنتشر والكتل الواضحة.</li>
	<li>اطلب من المريض الابتلاع ، ولاحظ أن الغضروف الحلقي ، والغضروف الدرقي ، والغدة الدرقية يتحرك لأعلى ولأسفل.</li>
</ol>
2. الجس
على الرغم من أنه يمكن ملامسة الغدة الدرقية من المواضع الأمامية أو الخلفية ، إلا أن النهج الأخير تقليدي.
<ol>
	<li>اطلب من المريض ثني الرقبة قليلا لإرخاء عضلات القص.</li>
	<li>من خلف المريض ، مد يدك بكلتا يديك واستخدم أصابعك لتحديد المعالم من أعلى إلى أسفل: العظم اللامي المتحرك أسفل الفك السفلي مباشرة ، والغضروف الدادرية مع الشق العلوي ، والغضروف الحلقي ، وحلقات القصبة الهوائية ، والشق العلوي</li>
	<li>ضع أصابع السبابة أسفل الغضروف الحلقي مباشرة.</li>
	<li>اطلب من المريض أن يبتلع كما كان من قبل ، ويشعر ببرزخ الغدة الدرقية الذي يرتفع تحت وسادات أصابعك. ليس دائما واضحا. اشعر بالحجم والشكل والاتساق ، مع ملاحظة أي عقيدات أو حنان.</li>
	<li>باستخدام أصابع يدك اليمنى ، حرك القصبة الهوائية برفق إلى اليسار واشعر بالفص الأيمن في الفراغ بين القصبة الهوائية والعضلة القصية.</li>
	<li>وبالمثل ، افحص الفص الأيسر.</li>
	<li>إذا تم اكتشاف تضخم الغدة الدرقية ، فاستمع إلى كدمة عن طريق وضع سماعة الطبيب فوق الفصوص الجانبية.</li>
</ol>

غالبا ما يرتبط تضخم الغدة الدرقية ، أو تضخم الغدة الدرقية ، بوظيفة الغدة الدرقية الطبيعية (الغدة الدرقية) ، ولكنه قد يترافق مع حالات فرط الغدة الدرقية أو قصور الغدة الدرقية. لذلك ، يجب أن يؤدي تشوه الغدة الدرقية الموجود في الفحص البدني إلى إجراء تقييم دقيق للعلامات والأعراض الجهازية المرتبطة بمستويات هرمون الغدة الدرقية المرتفعة والمنخفضة. قد يكون من الصعب ملامسة الغدة الدرقية الطبيعية ، خاصة في المرضى الذين يعانون من رقبة كبيرة. ومع ذلك ، يمكن تحديد موقعه بدقة من خلال تحديد المعالم العظمية والغضروفية القريبة: الغضروف ال...

فحص الغدة الدرقية

المصدر: ريتشارد جليكمان سيمون ، دكتوراه في الطب ، أستاذ مساعد ، قسم الصحة العامة وطب المجتمع ، كلية الطب بجامعة تافتس ، ماساتشوستس
تقع الغدة الدرقية في القصبة الهوائية الأمامية للرقبة بين الغضروف الحلقي (أعلاه) والشق العلوي (أدناه) (الشكل 1). يتكون من فص يمين ويسار متصل برزخ. يغطي البرزخ حلقات القصبة الهوائية الثانية والثالثة والرابعة ، وتنحني الفصوص للخلف حول جانبي القصبة الهوائية والمريء. عادة ما تكون الغدة الطبيعية ، التي تزن 10-25 جم ، غير مرئية عند الفحص وغالبا ما يصعب لمسها. تضخم الغدة الدرقية هو تضخم الغدة الدرقية لأي سبب. بالإضافة إلى تقييم حجمها ، من المهم ملامسة الغدة الدرقية من أجل شكلها وحركتها واتساقها وحنانها. الغدة الدرقية الطبيعية ناعمة وناعمة ومتناظرة وغير مؤلمة ، وتنزلق لأعلى قليلا عند البلع. يشير التوسع المتماثل للغدة الدرقية الناعمة والناعمة إلى قصور الغدة الدرقية المتوطن بسبب نقص اليود أو أحد اضطرابين من اضطرابات المناعة الذاتية السائدة: مرض جريفز أو التهاب الغدة الدرقية هاشيموتو. عقيدات الغدة الدرقية شائعة وعادة ما تكون عرضية. ومع ذلك ، فإن 10٪ من عقيدات الغدة الدرقية تبين أنها خبيثة. قد تكون مفردة أو متعددة ، وغالبا ما تكون صلبة وغير طرية. يشير تضخم الغدة الدرقية الرقيق والمتماثل عادة إلى التهاب الغدة الدرقية.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> 
الشكل 1. تشريح الغدة الدرقية. رسم توضيحي لموقع وتشريح الغدة الدرقية فيما يتعلق بهياكل الرقبة.
نادرا ما يظهر مرض الغدة الدرقية على شكل تضخم الغدة الدرقية المحسوس بمعزل عن غيره. تعمل هرمونات الغدة الدرقية على الحفاظ على التوازن في المقام الأول عن طريق تحفيز التمثيل الغذائي الخلوي في جميع أنحاء الجسم. وبالتالي ، يرتبط نقص نشاط الغدة الدرقية وفرط نشاط الغدة الدرقية بمجموعة من الأعراض والنتائج الجسدية (الجدول 1). من المهم ملاحظة أن تضخم الغدة الدرقية قد يكون الغدة الدرقية (مستويات هرمون الغدة الدرقية الطبيعية) أو فرط نشاط الغدة الدرقية أو قصور الغدة الدرقية. قد يشير الصداع أو الاضطرابات البصرية إلى اضطراب ثانوي في الغدة الدرقية بسبب الورم الحميد في الغدة النخامية
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
الجدول 1. الأعراض والنتائج الجسدية لقصور وفرط نشاط الغدة الدرقية.

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
The ...

Education

JoVE Science Education

Clinical Skills

المهارات السريرية

Physical Examinations II

الفحوصات البدنية ٢

palpating the thyroid for goiter

The thyroid gland sits in the front of the neck, in front of the trachea. It lies between the cricoid cartilage above and the suprasternal notch below. The gland has a right lobe and a left lobe joined by an isthmus, which covers the second, third, and fourth tracheal rings.

A normal thyroid weighs about 10 to 25 g. It is usually not visible on inspection and can be hard to feel. When the gland is enlarged, this is called a goiter, and the enlargement can have many causes.

During a thyroid exam, size is only one part of the assessment. The gland should also be checked for shape, mobility, consistency, and tenderness. A normal thyroid is soft, smooth, symmetrical, and non-tender. It also moves upward slightly when the patient swallows.

A smooth, symmetrical enlargement can suggest endemic hypothyroidism from iodine deficiency. It can also point to Graves' disease or Hashimoto's thyroiditis, which are common autoimmune disorders. Thyroid nodules are also common and are often found by chance. They may be single or multiple, and they are most often firm and non-tender, although about 10% are malignant.

A tender, symmetrical goiter usually suggests thyroiditis. Thyroid disease rarely appears as only a palpable goiter. Thyroid hormones help maintain homeostasis by stimulating cellular metabolism throughout the body, so hypo- and hyperthyroidism can cause many symptoms and physical findings. Goiters may be euthyroid, hyperthyroid, or hypothyroid. Headaches or visual changes may suggest a secondary thyroid disorder caused by a pituitary adenoma.

Palpating the Thyroid for Goiter

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This collection is a specialized edition featuring methodologies and procedures associated with more sensitive and comprehensive physical exams such as HEENT exams, abdominal exams, and  pelvic exams.

Learn how the thyroid is examined in the neck, what a normal gland feels like, and how goiter, nodules, and thyroiditis can suggest disease.

Palpating the Thyroid for Goiter | JoVE K12

Richard Glickman-Simon

Overview

Thyroid Anatomy and Physiology

Inspection and Palpation

Summary

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HS-LS1-1.

Palpating the Thyroid for Goiter

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