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. Ispezione
<ol><li>Ribaltare leggermente la testa del paziente e ispezionare attentamente il collo anteriore. Se visibile, la tiroide appare tra la cartilagine cricoide e la tacca soprasternale. Verificare la simmetria, il gonfiore diffuso e le masse evidenti.</li>
	<li>Far deglutire il paziente e osservare come la cartilagine cricoide, la cartilagine tiroidea e la ghiandola tiroidea si muovono su e giù.</li>
</ol>2. Palpate
Sebbene la tiroide possa essere palpata da posizioni anteriori o posteriori, quest'ultimo approccio è tradizionale.
<ol><li>Chiedere al paziente di flettere leggermente il collo per rilassare i muscoli sternomastoidi.</li>
	<li>Da dietro il paziente, raggiungi con entrambe le mani e usa le dita per identificare i punti di riferimento dall'alto verso il basso: osso ioide mobile appena sotto la mandibola, cartilagine tiroidea con la sua tacca superiore, cartilagine cricoide, anelli tracheali e tacca soprasternale.</li>
	<li>Posiziona l'indice appena sotto la cartilagine cricoide.</li>
	<li>Chiedi al paziente di deglutire come prima e senti l'istmo tiroideo che sale sotto i cuscinetti delle dita. Non è sempre palpabile. Senti per dimensioni, forma e consistenza, notando eventuali noduli o tenerezza.</li>
	<li>Usando le dita della mano destra, sposta delicatamente la trachea a sinistra e senti il lobo destro nello spazio tra la trachea e il muscolo sternomastoideo.</li>
	<li>Allo stesso modo esamina il lobo sinistro.</li>
	<li>Se viene rilevato un gozzo, ascolta un bruit posizionando lo stetoscopio sopra i lobi laterali.</li>
</ol>

Un ingrossamento della ghiandola tiroidea, o gozzo, è più spesso associato alla normale funzione della ghiandola tiroidea (eufroideo), ma può essere associato a condizioni iper- o ipotiroidee. Pertanto, l'anomalia tiroidea riscontrata all'esame fisico dovrebbe richiedere un'attenta valutazione per i segni e i sintomi sistemici associati a livelli di ormone tiroideo sia alti che bassi. Una tiroide normale può essere difficile da palpare, in particolare nei pazienti con colli grandi. Tuttavia, la sua posizione può essere d...

esame obiettivo della tiroide

Fonte: Richard Glickman-Simon, MD, Assistant Professor, Dipartimento di Sanità Pubblica e Medicina di Comunità, Tufts University School of Medicine, MA
La ghiandola tiroidea si trova nella trachea anteriore del collo tra la cartilagine cricoide (sopra) e la tacca soprasternale (sotto) (Figura 1). Consiste di un lobo destro e sinistro collegato da un istmo. L'istmo copre il secondo, il terzo e il quarto anello tracheale e i lobi si curvano posteriormente attorno ai lati della trachea e dell'esofago. La ghiandola normale, del peso di 10 - 25 g, è solitamente invisibile all'ispezione e spesso difficile da palpare. Un gozzo è una tiroide ingrossata da qualsiasi causa. Oltre a valutare le sue dimensioni, è importante palpare la tiroide per la sua forma, mobilità, consistenza e tenerezza. Una tiroide normale è morbida, liscia, simmetrica e non tenera, e scivola leggermente verso l'alto durante la deglutizione. L'allargamento simmetrico di una tiroide morbida e liscia suggerisce un ipotiroidismo endemico dovuto alla carenza di iodio o a uno dei due disturbi autoimmuni prevalenti: la malattia di Graves o la tiroidite di Hashimoto. I noduli tiroidei sono comuni e di solito incidentali; tuttavia, il 10% dei noduli tiroidei risulta essere maligno. Possono essere singoli o multipli e sono spesso fermi e non teneri. Un gozzo tenero e simmetrico indica tipicamente tiroidite.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> Figura 1. Anatomia della ghiandola tiroidea. Illustrazione della posizione e dell'anatomia della ghiandola tiroidea rispetto alle strutture del collo.
La malattia della tiroide raramente si manifesta come un gozzo palpabile in isolamento. Gli ormoni tiroidei servono a mantenere l'omeostasi principalmente stimolando il metabolismo cellulare in tutto il corpo. Pertanto, l'ipo e l'ipertiroidismo sono associati a una serie di sintomi e risultati fisici (Tabella 1). È importante notare che i gozzo possono essere eritroidei (normali livelli di ormone tiroideo), ipertiroidei o ipotiroidei. Mal di testa o disturbi visivi possono suggerire un disturbo secondario della tiroide a causa di un adenoma ipofisario
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
Tabella 1. Sintomi e risultati fisici per ipo- e iper-tiroidismo.

Esame obiettivo della tiroide

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

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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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Questa collezione è un'edizione specializzata che presenta metodologie e procedure associate a esami obiettivi più sensibili e completi come gli esami HEENT, gli esami addominali e gli esami pelvici.

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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Thyroid Anatomy and Physiology

Inspection and Palpation

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HS-LS1-1.

Palpating the Thyroid for Goiter

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