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. בדיקה
<ol><li>הטפו את ראשו של המטופל מעט לאחור, ובחנו בקפידה את הצוואר האחורי. אם נראה, בלוטת התריס מופיעה בין הסחוס cricoid חריץ על-עלתי. בדוק סימטריה, נפיחות מפוזרת, ומסות ברורות.</li>
	<li>יש לבלוע את המטופל, ולהתבונן כמו הסחוס cricoid, סחוס בלוטת התריס, בלוטת התריס לנוע למעלה ולמטה.</li>
</ol>2. מישוש
למרות בלוטת התריס יכול להיות palpated מתנוחות הקדמיות או האחוריות, הגישה האחרונה היא מסורתית.
<ol><li>בקש מהמטופל להגמיש מעט את הצוואר כדי להרגיע את שרירי החזה.</li>
	<li>מאחורי המטופל, הושט יד בשתי הידיים והשתמש באצבעות שלך כדי לזהות את ציוני הדרך מלמעלה למטה: עצם עצם עצם לשון ניידת ממש מתחת ללסת התחתונה, סחוס בלוטת התריס עם החרוז המעולה שלה, הסחוס cricoid, טבעות קנה הנשימה, וחרוז על-על- על.</li>
	<li>הנח את אצבעות האינדקס שלך ממש מתחת לסחוס cricoid.</li>
	<li>בקשו מהמטופל לבלוע כמו קודם, ותרגישו את בלוטת התריס מתרוממת מתחת לרפידות האצבעות. זה לא תמיד מוחשי. הרגש גודל, צורה ועקביות, וציין גושים או רוך.</li>
	<li>באמצעות האצבעות של יד ימין, בעדינות להזיז את קנה הנשימה שמאלה ולהרגיש את האונה הימנית בחלל בין קנה הנשימה לשריר sternomastoid.</li>
	<li>בדומה לכך, בחן את האונה השמאלית.</li>
	<li>אם זפק מזוהה, להקשיב bruit על ידי הצבת הסטטוסקופ מעל האונות לרוחב.</li>
</ol>

בלוטת התריס מוגדלת, או זפק, קשורה לרוב עם תפקוד בלוטת התריס נורמלי (המתת התריס), אבל עשוי להיות קשור עם מצבים היפר או בלוטת התריס. לכן, חריגות בבלוטת התריס שנמצאו בבדיקה גופנית צריכה להנחות הערכה זהירה של הסימנים והתסמינים המערכתיים הקשורים לרמות גבוהות ונמוכות של הורמון בלוטת התריס. בלוטת התריס נורמלית יכולה להיות קשה למחשוף, במיוחד בחולים עם צוואר גדול. עם זאת, מיקומו יכול להיקבע במדויק על ידי זיהוי ציוני הדרך הגרמיים והקרטלגינים הסמוכים: הסחוס הקריכויד מעל והחירץ העגול למטה. בנוסף לעלייה בגודל, הבלוטה עשויה להראות אסי...

בדיקת בלוטת התריס

מקור: ריצ'רד גליקמן-סיימון, MD, פרופסור עוזר, המחלקה לבריאות הציבור ורפואת הקהילה, בית הספר לרפואה של אוניברסיטת טאפטס, תואר שני
בלוטת התריס ממוקמת בקו המעצמה העורפי בצוואר בין הסחוס הקריכויד (למעלה) לבין החרוז הדו-סטריאלי (להלן) (איור 1). הוא מורכב מאונה ימנית ושמאלית המחוברת על ידי isthmus. האיסתמוס מכסה את טבעות קנה הנשימה השנייה, השלישית והרביעית, והאונות מתעקלות אחורית סביב צידי קנה הנשימה והוושט. הבלוטה הרגילה, במשקל 10 - 25 גרם, היא בדרך כלל בלתי נראית בבדיקה ולעתים קרובות קשה למחש. זפק הוא בלוטת התריס מוגדלת מכל סיבה שהיא. בנוסף להערכת גודלו, חשוב למשיק את בלוטת התריס על צורתה, ניידותה, עקביותה ורכותה. בלוטת התריס הרגילה רכה, חלקה, סימטרית ולא רכה, והיא מחליקה מעט כלפי מעלה בעת הבליעה. הגדלה סימטרית של בלוטת התריס הרכה והחלקה מרמזת על בלוטת התריס האנדמית עקב מחסור ביוד או אחת משתי הפרעות אוטואימוניות שכיחות: מחלת גרייבס או בלוטת התריס של השימוטו. גושי בלוטת התריס נפוצים ובדרך כלל מקריים; עם זאת, 10% של גושי בלוטת התריס להתברר ממאיר. הם עשויים להיות יחידים או מרובים, והם לרוב מוצקים ולא רכים. זפק רך וסימטרי בדרך כלל מצביע על דלקת בלוטת התריס.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> איור 1. אנטומיה של בלוטת התריס. איור של המיקום והאנטומיה של בלוטת התריס ביחס למבני הצוואר.
מחלת בלוטת התריס מתבטאת לעתים רחוקות כזפק מוחשי בבידוד. הורמוני בלוטת התריס משמשים כדי לשמור על הומאוסטזיס בעיקר על ידי גירוי חילוף החומרים התאי בכל הגוף. לכן, היפו בלוטת התריס קשורים למגוון תסמינים וממצאים פיזיים (טבלה 1). חשוב לציין כי זפקים עשויים להיות המתת תת התריס (רמות נורמליות של הורמון בלוטת התריס), בלוטת התריס, או בלוטת התריס. כאבי ראש או הפרעות ראייה עשויים להצביע על הפרעת בלוטת התריס משנית עקב אדנומה יותרת המוח
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
טבלה 1. תסמינים וממצאים פיזיים עבור היפו-בלוטת התריס.

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

מיומנויות קליניות

Physical Examinations II

בדיקות גופניות 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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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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