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. Inspekcja
<ol>
	<li>Przechyl głowę pacjenta lekko do tyłu i dokładnie sprawdź przednią część szyi. Jeśli tarczyca jest widoczna, pojawia się między chrząstką cricoid a wcięciem nadmostkowym. Sprawdź symetrię, rozproszone pęcznienie i oczywiste masy.</li>
	<li>Poproś pacjenta o połknięcie i obserwuj, jak chrząstka pierścienna, chrząstka tarczycy i tarczyca poruszają się w górę iw dół.</li>
</ol>
2. Badanie palpacyjne
Chociaż tarczycę można badać palpacyjnie zarówno z pozycji przedniej, jak i tylnej, to drugie podejście jest tradycyjne.
<ol>
	<li>Poproś pacjenta, aby lekko zgiął szyję, aby rozluźnić mięśnie mostkowo-sutkowe.</li>
	<li>Idąc od tyłu pacjenta, sięgnij obiema rękami i palcami zidentyfikuj punkty orientacyjne od góry do dołu: ruchomą kość gnykową tuż pod żuchwą, chrząstkę tarczycy z wcięciem górnym, chrząstkę sercowatą, pierścienie tchawicy i wcięcie nadmostkowe.</li>
	<li>Umieść palce wskazujące tuż poniżej chrząstki cricoid.</li>
	<li>Poproś pacjenta, aby połknął jak poprzednio i poczuj, czy przesmyk tarczycy unosi się pod opuszkami palców. Nie zawsze jest to wyczuwalne. Poczuj rozmiar, kształt i konsystencję, zwracając uwagę na wszelkie guzki lub tkliwość.</li>
	<li>Palcami prawej ręki delikatnie przesuń tchawicę w lewo i wyczuj prawy płat w przestrzeni między tchawicą a mięśniem mostkowo-sutkowym.</li>
	<li>Podobnie zbadaj lewy płat.</li>
	<li>Jeśli zostanie wykryte wole, nasłuchuj siniaka, umieszczając stetoskop na płatach bocznych.</li>
</ol>

Powiększenie tarczycy lub wole jest najczęściej związane z prawidłową funkcją tarczycy (eutarczycy), ale może być związane ze stanami nadczynności lub niedoczynności tarczycy. Dlatego nieprawidłowości tarczycy stwierdzone w badaniu fizykalnym powinny skłonić do dokładnej oceny ogólnoustrojowych oznak i objawów związanych zarówno z wysokim, jak i niskim poziomem hormonów tarczycy. Prawidłowa tarczyca może być trudna do badania palpacyjnego, szczególnie u pacjentów z dużymi szyjami. Jednak jego lokalizację można precyzyjni...

badanie tarczycy

Źródło: Richard Glickman-Simon, MD, adiunkt, Wydział Zdrowia Publicznego i Medycyny Środowiskowej, Tufts University School of Medicine, MA
Tarczyca znajduje się w przedniej tchawicy szyi między chrząstką pierzastą (powyżej) a wcięciem nadmostkowym (poniżej) (ryc. 1). Składa się z prawego i lewego płata połączonych przesmykiem. Przesmyk obejmuje drugi, trzeci i czwarty pierścień tchawicy, a płaty zakrzywiają się do tyłu wokół boków tchawicy i przełyku. Prawidłowy gruczoł, o wadze 10 - 25 g, jest zwykle niewidoczny podczas badania i często trudny do badania palpacyjnego. Wole to powiększona tarczyca z jakiejkolwiek przyczyny. Oprócz oceny jej wielkości ważne jest, aby obmacać tarczycę pod kątem jej kształtu, ruchomości, konsystencji i tkliwości. Normalna tarczyca jest miękka, gładka, symetryczna i nietkliwa, a podczas połykania lekko przesuwa się w górę. Symetryczne powiększenie miękkiej, gładkiej tarczycy sugeruje endemiczną niedoczynność tarczycy spowodowaną niedoborem jodu lub jedną z dwóch powszechnych chorób autoimmunologicznych: chorobę Gravesa-Basedowa lub zapalenie tarczycy typu Hashimoto. Guzki tarczycy są powszechne i zwykle przypadkowe; Jednak 10% guzków tarczycy okazuje się złośliwych. Mogą być pojedyncze lub wielokrotne, najczęściej twarde i nieprzetargowe. Delikatne, symetryczne wole zazwyczaj wskazuje na zapalenie tarczycy.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> 
Rysunek 1. Anatomia tarczycy. Ilustracja położenia i anatomii tarczycy w odniesieniu do struktur szyi.
Choroba tarczycy rzadko objawia się wyczuwalnym wolem w izolacji. Hormony tarczycy służą do utrzymania homeostazy przede wszystkim poprzez stymulację metabolizmu komórkowego w całym organizmie. Tak więc niedoczynność i nadczynność tarczycy są związane z szeregiem objawów i objawów fizycznych (Tabela 1). Ważne jest, aby pamiętać, że wole może być eutarczycowe (normalny poziom hormonów tarczycy), nadczynność tarczycy lub niedoczynność tarczycy. Bóle głowy lub zaburzenia widzenia mogą sugerować wtórne zaburzenie tarczycy spowodowane gruczolakiem przysadki
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
Tabela 1. Objawy i fizyczne objawy niedoczynności i nadczynności tarczycy.

Badanie tarczycy

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

Umiejętności kliniczne

Physical Examinations II

Badania fizykalne 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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physical examinations ii

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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