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. inspección
<ol>
	<li>Punta de la cabeza del paciente ligeramente hacia atrás e inspeccione cuidadosamente el cuello anterior. Si es visible, el tiroides aparece entre la muesca cricoides cartílago y suprasternal. Revise simetría, difusa masas hinchazón y obvio.</li>
	<li>Que el paciente trague y observar como el cartílago cricoides, cartílago tiroides y glándula tiroides mover arriba y abajo.</li>
</ol>
2. palpe
Aunque la tiroides puede ser palpated desde posiciones ya sea anteriores o posteriores, este último enfoque es tradicional.
<ol>
	<li>Pida al paciente a flexionar ligeramente el cuello para relajar los músculos esternocleidomastoideo.</li>
	<li>Por detrás del paciente, llegar a todo con ambas manos y utilice los dedos para identificar las señales de arriba a abajo: móvil hueso hioides justo debajo de la mandíbula, el cartílago tiroides con su muesca superior, cartílago cricoides, anillos traqueales y supraesternal.</li>
	<li>Coloque sus dedos índice justo debajo del cartílago cricoides.</li>
	<li>Pida al paciente que trague como antes y siento por el Istmo de tiroides levantándose en sus cojines del dedo. No siempre es palpable. Siento por tamaño, forma y consistencia, observando nódulos ni ternura.</li>
	<li>Suavemente con los dedos de la mano derecha, mueva la tráquea a la izquierda y siento por el lóbulo derecho en el espacio entre el músculo de tráquea y esternocleidomastoideo.</li>
	<li>Asimismo examinar el lóbulo izquierdo.</li>
	<li>Si se detecta un bocio, escuche un soplo colocando el estetoscopio en el lóbulos laterales.</li>
</ol>

Un agrandamiento de la glándula tiroides o bocio, más a menudo se asocia con la función normal de la glándula tiroides (eutiroideo), pero puede estar asociado con hiper- o hipotiroidismo. Por lo tanto, anormalidad de la tiroides que se encuentran en el examen físico debe incitar una evaluación cuidadosa de los signos sistémicos y síntomas asociados con ambos altos y bajos niveles de hormona tiroidea. Una tiroides normal puede ser difícil de palpar, especialmente en pacientes con cuellos grandes. Sin embargo, su localizac...

exploración de la tiroides

Fuente: Richard Glickman-Simon, MD, profesor asistente, Departamento de salud pública y medicina comunitaria, Tufts University School of Medicine, MA
La glándula tiroides se encuentra en la tráquea anterior del cuello entre el cartílago cricoides (arriba) y la muesca del suprasternal (abajo) (figura 1). Consiste en un lóbulo derecho e izquierdo conectado por un istmo. El istmo abarca al segundo, tercero, y cuarto traqueales anillos y los lóbulos de la curva posteriorly alrededor de los lados de la tráquea y el esófago. La glándula normal, peso de 10-25 g, es generalmente invisible en la inspección y a menudo difíciles de palpar. Un bocio es un agrandamiento tiroideo por cualquier causa. Además de evaluar su tamaño, es importante palpar la tiroides por su forma, movilidad, consistencia y sensibilidad. Una tiroides normal es suave, liso, simétrico y no blanda, y se desliza hacia arriba un poco al tragar. La ampliación simétrica de un suave, lisa tiroides sugiere hipotiroidismo endémico debido a la deficiencia de yodo o una de dos enfermedades autoinmunes frecuentes: enfermedad de Graves o tiroiditis de Hashimoto. Los nódulos tiroideos son comunes y generalmente accidental; sin embargo, el 10% de nódulos de la tiroides resultan para ser malignos. Pueden ser únicas o múltiples y frecuentemente son firmes y no blanda. Típicamente, un bocio blando, simétrico indica tiroiditis.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> 
Figura 1. Anatomía de la glándula tiroides. Ilustración de la ubicación y anatomía de la glándula tiroides con respecto a las estructuras del cuello.
Enfermedad tiroidea raramente se manifiesta como un bocio palpable en aislamiento. Las hormonas tiroideas sirven para mantener la homeostasis principalmente por estimulación metabolismo celular en todo el cuerpo. Por lo tanto, hipo e hipertiroidismo están asociados con una variedad de síntomas y hallazgos físicos (tabla 1). Es importante tener en cuenta que esta afección puede ser eutiroideo (niveles normales de hormonas tiroideas), hipertiroidismo o hipotiroidismo. Dolores de cabeza o trastornos visuales pueden sugerir un trastorno tiroideo secundario a un adenoma pituitario
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
Tabla 1. Los síntomas y hallazgos físicos para hypo - e hiper-tiroidismo.

Exploración de la tiroides

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

Education

Educación

JoVE Science Education

Clinical Skills

Habilidades Clínicas

Physical Examinations II

Exámenes Físicos II

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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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

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Inspection and Palpation

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HS-LS1-1.

Palpating the Thyroid for Goiter

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