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. Inspectie
<ol>
	<li>Kanteel het hoofd van de patiënt lichtjes naar achteren en inspecteer zorgvuldig de voorste hals. Indien zichtbaar, verschijnt de schildklier tussen het cricoïde kraakbeen en de suprasternale inkeping. Controleer op symmetrie, diffuse zwelling en duidelijke massa's.</li>
	<li>Laat de patiënt slikken en observeer hoe de cricoïde kraakbeen, schildklierkraakbeen en schildklier omhoog en omlaag bewegen.</li>
</ol>
2. Palperen
Hoewel de schildklier vanuit zowel voorste als achterste posities kan worden gepalpeerd, is de laatste aanpak traditioneel.
<ol>
	<li>Vraag de patiënt om de nek lichtjes te buigen om de sternomastoid-spieren te ontspannen.</li>
	<li>Van achter de patiënt, reik met beide handen om en gebruik je vingers om de oriëntatiepuntjes van boven naar beneden te identificeren: beweeglijk hyoïd-bot direct onder de onderkaak, schildklierkraakbeen met zijn superieure inkeping, cricoïde kraakbeen, tracheale ringen en suprasternale inkeping.</li>
	<li>Plaats je wijsvingers net onder het cricoïde kraakbeen.</li>
	<li>Vraag de patiënt om te slikken zoals eerder en voel of de schildklier isthmus onder je vingerkussens omhoog komt. Het is niet altijd palpabel. Voel naar grootte, vorm en consistentie, en noteer eventuele knobbeltjes of gevoeligheid.</li>
	<li>Gebruik de vingers van je rechterhand om voorzichtig de luchtpijp naar links te bewegen en voel naar de rechterkwab in de ruimte tussen de luchtpijp en sternomastoid-spier.</li>
	<li>Onderzoek op dezelfde manier de linkerkwab.</li>
	<li>Indien een goiter wordt gedetecteerd, luister dan naar een bruit door het stethoscoop over de laterale kwabben te plaatsen.</li>
</ol>

Een vergrote schildklier, of struma, wordt meestal geassocieerd met een normale schildklierfunctie (euthyroïde), maar kan ook geassocieerd zijn met hyper- of hypothyreoïdie. Daarom moet een schildklierafwijking die bij lichamelijk onderzoek wordt gevonden, leiden tot een zorgvuldige evaluatie van de systemische tekenen en symptomen die geassocieerd zijn met zowel hoge als lage schildklierhormoonniveaus. Een normale schildklier kan moeilijk te palperen zijn, vooral bij patiënten met een grote nek. De locatie ervan kan ech...

schildklieronderzoek

Bron: Richard Glickman-Simon, MD, assistent-professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
De schildklier bevindt zich in de nek voor de luchtpijp tussen het cricoïde kraakbeen (boven) en de suprasternale inkeping (onder) (Figuur 1). Het bestaat uit een rechter- en linkerkwab die met elkaar verbonden zijn door een isthmus. De isthmus bedekt de tweede, derde en vierde tracheale ringen, en de kwabben buigen achterwaarts rond de zijkanten van de luchtpijp en slokdarm. De normale klier, met een gewicht van 10 - 25 g, is meestal onzichtbaar bij inspectie en vaak moeilijk te palperen. Een goed is een vergrote schildklier vanwege een of andere oorzaak. Naast het beoordelen van de grootte, is het belangrijk om de schildklier te palperen op zijn vorm, mobiliteit, consistentie en gevoeligheid. Een normale schildklier is zacht, glad, symmetrisch en niet gevoelig en schuift lichtjes omhoog bij het slikken. Symmetrische vergroting van een zachte, gladde schildklier suggereert endemische hypothyreoïdie als gevolg van jodiumtekort of een van twee prevalente auto-immuunziekten: de ziekte van Graves of Hashimoto's thyroiditis. Schildklierknobbeltjes zijn gebruikelijk en meestal incidenteel; echter, 10% van de schildklierknobbeltjes blijken kwaadaardig te zijn. Ze kunnen enkelvoudig of veelvoudig zijn, en zijn meestal stevig en niet gevoelig. Een gevoelige, symmetrische goed geeft meestal thyroiditis aan.
<img alt="Diagram van de schildklier anatomie; toont schildklierkwabben, cricoïde kraakbeen, luchtpijp, isthmus, sternale inkeping." src="/files/ftp_upload/10098/10098fig1.jpg" data-altupdatedat="1761830439000" data-alt="Figuur 1"> 
Figuur 1. Anatomie van de schildklier. Illustratie van de locatie en anatomie van de schildklier met betrekking tot de nekstructuren.
Schildklierziekte manifesteert zich zelden als een voelbare goed op zichzelf. Schildklierhormonen dienen om homeostase te handhaven, voornamelijk door de cellulaire stofwisseling door het hele lichaam te stimuleren. Dus, hypo- en hyperthyreoïdie worden geassocieerd met een reeks symptomen en fysieke bevindingen (Tabel 1). Het is belangrijk op te merken dat goeds euthyroïde (normale schildklierhormoonniveaus), hyperthyroïde of hypothyroïde kunnen zijn. Hoofdpijn of visuele stoornissen kunnen wijzen op een secundaire schildklierziekte als gevolg van een hypofyse-adenomen
<img alt="Vergelijkende grafiek van hyperthyreoïdie en hypothyreoïdie symptomen en fysieke bevindingen." src="/files/ftp_upload/10098/10098table1.jpg" data-altupdatedat="1761830439000" data-alt="Tabel 1">
Tabel 1. Symptomen en fysieke bevindingen voor hypo- en hyperthyreoïdie.

Schildklieronderzoek

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

Klinische vaardigheden

Physical Examinations II

Lichamelijk onderzoek 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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