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. 检查
<ol>
	<li>让患者头部稍向后仰，仔细检查颈部前方。若可见，甲状腺位于环状软骨与胸骨上窝之间。检查其对称性、弥漫性肿胀及明显肿块。</li>
	<li>让患者做吞咽动作，观察环状软骨、甲状软骨及甲状腺上下移动的情况。</li>
</ol>
2. 触诊
尽管可以从前方或后方触诊甲状腺，但传统方法采用后方入路。
<ol>
	<li>嘱患者轻微屈颈，以放松胸锁乳突肌。</li>
	<li>站在患者后方，双手绕至前方，用手指自上而下触诊解剖标志：下颌骨下方可移动的舌骨、具有上切迹的甲状软骨、环状软骨、气管软骨环以及胸骨上切迹。</li>
	<li>将食指置于环状软骨下方。</li>
	<li>嘱患者如前吞咽，感受甲状腺峡部在指腹下上升，其大小、形状和质地可能因人而异，注意是否有结节或压痛，但峡部并不总是可触及。</li>
	<li>用右手手指轻轻将气管推向左侧，在气管与胸锁乳突肌之间的间隙内触诊右叶。</li>
	<li>以同样方法检查左叶。</li>
	<li>若发现甲状腺肿大，应将听诊器置于甲状腺侧叶处听诊，检查是否存在杂音。</li>
</ol>

甲状腺肿大（即甲状腺肿）通常与正常的甲状腺功能（ euthyroid ）相关，但也可能与甲状腺功能亢进或减退有关。因此，体格检查中发现甲状腺异常时，应仔细评估与甲状腺激素水平升高或降低相关的全身性体征和症状。正常甲状腺可能难以触及，尤其是在颈部较粗的患者中。然而，可通过识别邻近的骨性和软骨性解剖标志精确定位：上方为环状软骨，下方为胸骨上切迹。除了体积增大外，甲状腺还可能出现不对称、结节性改变或压痛。对称性甲状腺肿和甲状腺结节并不少见，一旦发现应始终进一步检查。

甲状腺检查

来源：Richard Glickman-Simon，医学博士，美国马萨诸塞州塔夫茨大学医学院公共卫生与社区医学系助理教授
甲状腺位于颈部气管前方，介于环状软骨（上方）与胸骨上切迹（下方）之间（图1）。它由左右两叶组成，中间通过峡部相连。峡部覆盖第2、3和第4气管环，两叶则向后包绕气管和食管两侧。正常甲状腺重约10–25 g，视诊时通常不可见，触诊时常难以触及。甲状腺肿是指任何原因引起的甲状腺肿大。除评估其大小外，触诊时还需注意其形状、活动度、质地及有无压痛。正常甲状腺质地柔软、表面光滑、对称且无压痛，吞咽时可轻微上移。质地柔软、表面光滑的对称性肿大提示地方性甲状腺功能减退症（由碘缺乏引起），或两种常见的自身免疫性疾病之一：格雷夫斯病（Graves' disease）或桥本甲状腺炎（Hashimoto's thyroiditis）。甲状腺结节较为常见，通常为偶然发现；然而，约10%的甲状腺结节为恶性。结节可为单发或多发，多数质地较硬且无压痛。伴有压痛的对称性甲状腺肿大通常提示甲状腺炎。
<img alt="甲状腺解剖图；显示甲状腺叶、环状软骨、气管、峡部、胸骨切迹。" src="/files/ftp_upload/10098/10098fig1.jpg" data-altupdatedat="1761830439000" data-alt="图1"> 
图1. 甲状腺的解剖结构。 示甲状腺在颈部结构中的位置及其解剖结构的示意图。
甲状腺疾病很少仅以可触及的甲状腺肿为单一表现。甲状腺激素主要通过刺激全身细胞代谢来维持内环境稳定。因此，甲状腺功能减退和甲状腺功能亢进均伴有多种症状和体征（表1）。需要注意的是，甲状腺肿可能表现为甲状腺功能正常（甲状腺激素水平正常）、甲状腺功能亢进或甲状腺功能减退。头痛或视觉障碍可能提示由于垂体腺瘤引起的继发性甲状腺疾病
<img alt="甲状腺功能亢进与甲状腺功能减退症状及体征的比较图表。" src="/files/ftp_upload/10098/10098table1.jpg" data-altupdatedat="1761830439000" data-alt="表 1">
表1. 甲状腺功能减退与甲状腺功能亢进的症状及体格检查结果。

来源：Richard Glickman-Simon，医学博士，塔夫茨大学医学院公共卫生与社区医学系助理教授，马萨诸塞州

Education

教育

JoVE Science Education

Clinical Skills

临床技能

Physical Examinations II

体格检查 II

甲状腺考试

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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这是一个专门的版本, 包括方法和程序与更敏感和全面的物理考试, 如 HEENT 考试, 腹部考试, 和骨盆考试。

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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