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. Inspeção
<ol><li>Incline a cabeça do paciente ligeiramente para trás, e inspecione cuidadosamente o pescoço anterior. Se visível, a tireoide aparece entre a cartilagem cricoide e o entalhe suprasternal. Verifique se há simetria, inchaço difuso e massas óbvias.</li>
	<li>Que o paciente engula, e observe como a cartilagem cricoide, cartilagem tireoide e glândula tireoide se movem para cima e para baixo.</li>
</ol>2. Palpate
Embora a tireoide possa ser palpatada de posições anteriores ou posteriores, a última abordagem é tradicional.
<ol><li>Peça ao paciente para flexionar ligeiramente o pescoço para relaxar os músculos estemastoides.</li>
	<li>Por trás do paciente, alcance as duas mãos e use os dedos para identificar os marcos de cima a baixo: osso hioide móvel logo abaixo da mandíbula, cartilagem tireoide com seu entalhe superior, cartilagem cricoide, anéis traqueais e entalhe suprasternal.</li>
	<li>Coloque seus dedos indicadores logo abaixo da cartilagem cricoide.</li>
	<li>Peça ao paciente para engolir como antes, e sinta pelo istmo da tireoide subindo sob suas almofadas. Nem sempre é palpável. Sinta o tamanho, a forma e a consistência, observando nenhum nódulo ou ternura.</li>
	<li>Usando os dedos da mão direita, mova suavemente a traqueia para a esquerda e sinta o lobo direito no espaço entre a traqueia e o músculo estemastoide.</li>
	<li>Da mesma forma, examine o lobo esquerdo.</li>
	<li>Se um goiter for detectado, ouça um bruit colocando o estetoscópio sobre os lóbulos laterais.</li>
</ol>

Uma glândula tireoide aumentada, ou goiter, é mais frequentemente associada com a função normal da glândula tireoide (eutireóide), mas pode estar associada a condições hiper ou hipotireóides. Portanto, a anormalidade da tireoide encontrada no exame físico deve levar a uma avaliação cuidadosa para os sinais e sintomas sistêmicos associados aos níveis elevados e baixos de hormônio da tireoide. Uma tireoide normal pode ser difícil de palpar, particularmente em pacientes com pescoços grandes. No entanto, sua localização pode...

exame da tireoide

Fonte: Richard Glickman-Simon, MD, Professor Assistente, Departamento de Saúde Pública e Medicina Comunitária, Tufts University School of Medicine, MA
A glândula tireoide está localizada na traqueia anterior do pescoço entre a cartilagem cricoide (acima) e o entalhe suprasternal (abaixo)(Figura 1). Consiste em um lobo direito e esquerdo conectado por um istmo. O istmo cobre o segundo, terceiro e quarto anéis traqueais, e os lóbulos curvam-se posteriormente ao redor das laterais da traqueia e do esôfago. A glândula normal, pesando 10 a 25 g, geralmente é invisível na inspeção e muitas vezes difícil de palpar. Um goiter é uma tireoide aumentada de qualquer causa. Além de avaliar seu tamanho, é importante palpar a tireoide por sua forma, mobilidade, consistência e ternura. Uma tireoide normal é macia, lisa, simétrica e não macia, e desliza ligeiramente para cima ao engolir. O alargamento simétrico de uma tireoide macia e lisa sugere hipotireoidismo endêmico devido à deficiência de iodo ou uma das duas doenças autoimunes prevalentes: doença de Graves ou tireoidite de Hashimoto. Nódulos da tireoide são comuns e geralmente incidentais; no entanto, 10% dos nódulos da tireoide acabam por ser malignos. Eles podem ser únicos ou múltiplos, e são na maioria das vezes firmes e não-ternos. Um goiter macio e simétrico normalmente indica tireoidite.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> Figura 1. Anatomia da glândula tireoide. Ilustração da localização e anatomia da glândula tireoide em relação às estruturas do pescoço.
A doença da tireoide raramente se manifesta como um goiter palpável isoladamente. Os hormônios da tireoide servem para manter a homeostase principalmente estimulando o metabolismo celular em todo o corpo. Assim, hipo e hipertireoidismo estão associados a uma série de sintomas e achados físicos (Tabela 1). É importante notar que os goiters podem ser eutireóide (níveis hormonais normais da tireoide), hipertireoid, ou hipotireóide. Dores de cabeça ou distúrbios visuais podem sugerir um distúrbio secundário da tireoide devido a um adenoma pituitário
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
Mesa 1. Sintomas e achados físicos para hipo-e hiper-tireoidismo.

Exame da Tireoide

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

Habilidades Clínicas

Physical Examinations II

Exames 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

eye exam

Eye Exam: Anatomy and Vision Testing

An eye exam uses vision testing, orbit inspection, and an ophthalmoscopic exam to check eye health. It also helps connect eye findings with the nervous system. Before the exam, it is important to know the basic anatomy and function of the eye. The upper eyelid should sit slightly over the iris, but it should not cover the pupil when the eye is open. The lower lid lies below the iris. A normal sclera looks white or slightly buff, and the conjunctiva is a clear membrane over the front of the...

ophthalmoscopic examination

Eye Fundus Exam with an Ophthalmoscope

An ophthalmoscope is used to examine the fundus, which is the inner wall of the back of the eye. The fundus includes the choroid, retina, fovea, macula, optic disc, and retinal vessels. A simple ophthalmoscope has an aperture to look through, a diopter indicator, and a disc for selecting lenses. During a funduscopic exam, the first landmark seen is usually the optic disc. This is the point where the optic nerve and retinal vessels enter the back of the eye. The disc often has a central whitish...

ear exam

Ear Anatomy and Otoscope Findings

The ear exam begins with the outer ear and continues through the structures that carry sound inward. The cartilaginous auricle includes the helix, antihelix, earlobe, and tragus. The mastoid process sits just behind the earlobe. The auditory canal curves gently until it reaches the tympanic membrane, also called the eardrum. This membrane passes sound waves from the external ear to the air-filled middle ear. The Eustachian tube connects the middle ear to the nasopharynx. Sound then moves...

nose, sinuses, oral cavity and pharynx exam

nose-sinuses-oral-cavity-and-pharynx-exam

Examining the Nose, Mouth, and Throat

Examining the nose, oral cavity, and pharynx starts with the basic anatomy of these regions. The upper third of the nose is bony, and the lower two-thirds are cartilaginous. Air enters through the nares, or nostrils, and moves through the nasal vestibules into the narrow space between the nasal septum and the bony turbinates. Each turbinate curves inward and creates a meatus, which is a groove below it. The nasolacrimal duct and most of the air-filled paranasal sinuses drain into the inferior...

thyroid exam

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...

lymph node exam

Lymph Node Findings in Health and Disease

Lymph node findings can help reveal how the lymphatic system is working and what disease may be present. The lymphatic system has two main jobs: it returns extracellular fluid to the venous circulation and exposes antigenic substances to the immune system. As lymph moves through the body, it passes through nodes made of dense clusters of lymphocytes, which are immune cells. Most lymph channels and nodes are deep in the body and cannot be reached by physical exam. Only surface nodes can be seen...

abdominal exam i: inspection and auscultation

abdominal-exam-i-inspection-and-auscultation

Abdominal Exam: Surface Landmarks and Regions

Abdominal exam starts with inspection and auscultation of the abdomen, along with a clear understanding of surface landmarks and regions. Gastrointestinal disease accounts for many office visits and hospital admissions each year, so a careful abdominal exam is an important clinical tool. It can also point to problems in the cardiovascular, urinary, and other systems. The abdominal examination also helps build physician-patient contact, support a preliminary diagnosis, guide later lab and...

abdominal exam ii: percussion

Abdominal Percussion for Organ Size Checks

Abdominal percussion is a physical exam technique that uses tapping to find differences in sound. The pitch changes because the body wall vibrates differently depending on the organs underneath, the strength of the tap, and the condition of the body wall. Doctors use this method to help judge organ size, find masses, and look for fluid or areas of tissue consolidation. Three main percussion sounds are heard in medical exam. Resonance is heard over the lungs. Tympany is heard over air-filled...

abdominal exam iii: palpation

Abdominal Palpation for Organ and Pain Assessment

Abdominal palpation helps clinicians check for tenderness, enlarged organs, and tumors. It also supports a broader abdominal exam by adding hands-on information about where a problem may be and how severe it might be. When performed correctly, palpation can assess large, relatively superficial organs. With skill, it can also give clues about smaller and deeper structures. The amount of information gained can vary with the patient's body build. For example, obesity can make it harder to feel...

abdominal exam iv: acute abdominal pain assessment

abdominal-exam-iv-acute-abdominal-pain-assessment

Mapping Acute Abdominal Pain by Location

Acute abdominal pain needs a careful, organized exam. Acute pain means pain lasting less than seven days. An acute abdomen is the sudden start of severe pain with signs that may point to a problem needing surgery. The cause of abdominal pain can be broad, so the history matters. Pain may also come from outside the abdomen, including pulmonary, cardiac, rectal, and genital disorders. For that reason, the exam should follow a clear plan rather than a quick guess. Doctors use standard location...

male rectal exam

Male Rectal Exam: Anatomy and Findings

The male rectal exam is an important part of the physical exam. It is used in selected patients with lower urinary tract symptoms, urinary or fecal incontinence or retention, back pain, anorectal symptoms, abdominal complaints, trauma, unexplained anemia, weight loss, or bone pain. Its role in cancer screening is debated, but the exam still has clinical value. There are no absolute contraindications to the rectal exam. Relative contraindications include patient unwillingness, severe rectal...

comprehensive breast exam

Breast Exam Comfort and Anatomy

Breast exams require both careful technique and patient comfort. They are a key part of an annual gynecological exam and are important for patients of any sex or gender expression. Because the exam can feel invasive, the examiner should use clear communication and help the patient stay in control whenever possible. Patient comfort starts with respectful behavior and careful word choice. The patient should be allowed to remove their own gown, and a chaperone may be used for the comfort of both...

pelvic exam i: assessment of the external genitalia

pelvic-exam-i-assessment-of-the-external-genitalia

Pelvic Exam I: Patient Comfort and External Check

Pelvic exam communication and the external genitalia check are important parts of patient care. The exam can feel invasive, so clinicians should help patients feel comfortable and empowered instead of vulnerable. Verbal and nonverbal communication both matter, and patients should be given control whenever possible. The approach shown here uses neutral language and simple steps that can work for many patients. It also helps reduce the chance of triggering patients who may have experienced...

pelvic exam ii: speculum exam

Choosing the Right Speculum for a Pap Test

Choosing the right speculum for a Pap test is an important part of gynecological care. A speculum helps the clinician view the cervix and collect a sample without causing unnecessary discomfort. Many patients and providers feel anxious about the exam, so careful technique and calm language matter. For example, providers should say “bills” instead of “blades” when describing the speculum. There are two main types of speculums: metal and plastic. This demonstration uses a plastic speculum, which...

pelvic exam iii:  bimanual and rectovaginal exam

pelvic-exam-iii-bimanual-and-rectovaginal-exam

Bimanual Pelvic Exam for Organ Assessment

A bimanual pelvic exam is a hands-on check of the cervix, uterus, and ovaries. It helps an experienced provider feel for changes that may point to cysts, fibroids, or malignancies. It also gives the clinician a baseline sense of the patient’s anatomy for later reference. Performing the bimanual exam before the speculum exam can help the patient feel more relaxed, both mentally and physically, before what is often seen as the most invasive part of the exam. If the provider already knows the...

physical examinations ii

Esta coleção é uma edição especializada com metodologias e procedimentos associados a exames físicos mais sensíveis e abrangentes, como exames HEENT, exames abdominais e exames pélvicos.

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

Characteristics of Life

Biology is a natural science that studies life and living organisms, including their structure, function, development, interactions, evolution, ...

https://cloudfront.jove.com/files/media/science-education/science-education-thumbs/10647.jpg

Cell Structure

Background
Cells represent the most basic biological units of all organisms, whether it be simple, single-celled organisms like bacteria, or large, ...

Visualizing Onion and Cheek Cells
ExpandImmediately before the experiment, wash and peel onion bulbs for the class.
Remove the entire brown outer skin and ...

Visualizing Onion and Human Cells
ExpandIn this experiment you will prepare different types of cells from a plant and animal, onion and human ...

What are Cells?

Cell Diversity

The concept of a cell started with microscopic observations of dead cork tissue by Robert Hooke in 1665. Hooke coined the term &#34;cell&#34; based on the ...

Cytoplasm

The cytoplasm consists of organelles and a framework of protein scaffolds called the cytoskeleton suspended in an aqueous solution, the cytosol. The ...

The Nucleus

The nucleus is a membrane-bound organelle that acts as a control center in a eukaryotic cell. It contains chromosomal DNA, which controls gene expression ...

The Central Dogma

The DNA Helix

Nucleic Acids

DNA as a Genetic Template

Structure of a Gene

A gene is the fundamental unit of heredity. Every individual has two copies of each gene, one inherited from each parent. Although most people contain the ...

Chromosome Structure

Base-pairing and DNA Repair

What is Gene Expression?

A gene is a stretch of DNA that serves as the blueprint for functional RNAs and proteins. Since DNA is comprised&#160; of nucleotides and proteins are ...

RNA Structure

The basic structure of RNA consists of a string of ribonucleotides attached by phosphodiester bonds. Although most RNA is single-stranded, it can form ...

Types of RNA

Three main types of RNA are involved in protein synthesis: messenger RNA (mRNA), transfer RNA (tRNA), and ribosomal RNA (rRNA). These RNAs perform diverse ...

Transcription

Transcription is the synthesis of RNA from a DNA sequence by RNA polymerase. It is the first step in producing a protein from a gene sequence. ...

Translation

Translation is the process of synthesizing proteins from the genetic information carried by messenger RNA (mRNA). Following transcription, it constitutes ...

Ribosomes

Ribosomes translate genetic information encoded by messenger RNA (mRNA) into proteins. Both prokaryotic and eukaryotic cells have ribosomes. Cells that ...

Protein and Protein Structures

Proteins: From Genes to Degradation

From DNA to Protein

The flow of genetic information in cells from DNA to mRNA to protein is described by the central dogma, which states that genes specify the sequence of ...

Protein Folding

Proteins are chains of amino acids linked together by peptide bonds. Upon synthesis, a protein folds into a three-dimensional conformation, critical to ...

An Overview of Gene Expression

Gene expression is the complex process where a cell uses its genetic information to make functional products. This process is regulated at multiple ...

an-introduction-to-caenorhabditis-elegans

An Introduction to Caenorhabditis elegans

Caenorhabditis elegans is a microscopic, soil-dwelling roundworm that has been powerfully used as a model organism since the early 1970&rsquo;s.  It was ...

An Overview of Genetic Analysis

An organism&#8217;s physical traits, or phenotype, are a product of its genotype, which is the combination of alleles (gene variants) inherited from its ...

An Introduction to Cell Death

Necrosis, apoptosis, and autophagic cell death are all manners in which cells can die, and these mechanisms can be induced by different stimuli, such as ...

An Overview of Genetic Engineering

Genetic engineering &#8211; the process of purposefully altering an organism&#8217;s DNA &#8211; has been used to create powerful research tools and model ...

An Introduction to Cell Division

Cell division is the process by which a parent cell divides and gives rise to two or more daughter cells. It is a means of reproduction for single-cell ...

An Overview of Genetics and Disease

Many human diseases are associated with mutations or variations in genetic sequences. Some of these genetic variants are heritable, passed down from ...

an-introduction-to-cellular-and-molecular-neuroscience

An Introduction to Cellular and Molecular Neuroscience

Cellular and molecular neuroscience is one of the newest and fastest growing subdisciplines in neuroscience. By investigating the influences of genes, ...

Annexin V and Propidium Iodide Labeling

Staining with annexin V and propidium iodide (PI) provides researchers with a way to identify different types of cell death&#8212;either necrosis or ...

an-introduction-to-developmental-genetics

An Introduction to Developmental Genetics

Development is the complex process through which a single-celled embryo transforms into a multicellular organism. Developmental processes are guided by ...

Bacterial Transformation: Electroporation

The term &#x201C;transformation&#x201D; refers cellular ingestion of foreign DNA.  In nature, transformation can occur in certain types of bacteria.  In ...

an-introduction-to-molecular-developmental-biology

An Introduction to Molecular Developmental Biology

Molecular signals play a major role in the complex processes occurring during embryonic development. These signals regulate activities such as cell ...

bacterial-transformation-the-heat-shock-method

Bacterial Transformation: The Heat Shock Method

Transformation is the process that occurs when a cell ingests foreign DNA from its surroundings. Transformation can occur in nature in certain types of ...

an-introduction-to-saccharomyces-cerevisiae

An Introduction to Saccharomyces cerevisiae

Saccharomyces cerevisiae (commonly known as baker&rsquo;s yeast) is a single-celled eukaryote that is frequently used in scientific research.  S. ...

Cell Cycle Analysis

Cell cycle refers to the set of events through which a cell grows, replicates its genome, and ultimately divides into two daughter cells through the ...

An Introduction to Transfection

Transfection is the process of inserting genetic material, such as DNA and double stranded RNA, into mammalian cells. The insertion of DNA into a cell ...

Chromatin Immunoprecipitation

Histones are proteins that help organize DNA in eukaryotic nuclei by serving as &#8220;scaffolds&#8221; around which DNA can be wrapped, forming a complex ...

An Overview of Epigenetics

Since the early days of genetics research, scientists have noted certain heritable phenotypic differences that are not due to differences in the ...

community-dna-extraction-from-bacterial-colonies

Community DNA Extraction from Bacterial Colonies

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - The University of Arizona
Demonstrating Author: Luisa Ikner
Traditional methods of analysis ...

Cytogenetics

Cytogenetics is the field of study devoted to chromosomes, and involves the direct observation of a cell&#8217;s chromosomal number and structure, ...

embryonic-stem-cell-culture-and-differentiation

Embryonic Stem Cell Culture and Differentiation

Culturing embryonic stem (ES) cells requires conditions that maintain these cells in an undifferentiated state to preserve their capacity for self-renewal ...

DNA Gel Electrophoresis

DNA gel electrophoresis is a technique used for the detection and separation of DNA molecules. An electric field is applied to a gel matrix comprised of ...

Enzyme Assays and Kinetics

Enzyme kinetics describes the catalytic effects of enzymes, which are biomolecules that facilitate chemical reactions necessary for living organisms. ...

DNA Ligation Reactions

In molecular biology, ligation refers to the joining of two DNA fragments through the formation of a phosphodiester bond.  An enzyme known as a ligase ...

explant-culture-for-developmental-studies

Explant Culture for Developmental Studies

Explant culture is a technique in which living cells or tissues are removed from an embryo for continued development outside of the organism. This ex vivo ...

DNA Methylation Analysis

Methylation at CpG dinucleotides is a chemical modification of DNA hypothesized to play important roles in regulating gene expression. In particular, the ...

Expression Profiling with Microarrays

Microarrays are important tools for profiling gene expression, and are based on complementary binding between probes that are attached to glass chips and ...

Density Gradient Ultracentrifugation

Density gradient ultracentrifugation is a common technique used to isolate and purify biomolecules and cell structures. This technique exploits the fact ...

F&#246;rster Resonance Energy Transfer (FRET)

F&#246;rster resonance energy transfer (FRET) is a phenomenon used to investigate close-range biochemical interactions. In FRET, a donor photoluminescent ...

detecting-environmental-microorganisms-with-polymerase-chain-reaction

Detecting Environmental Microorganisms with the Polymerase Chain Reaction and Gel Electrophoresis

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - Arizona University
Demonstrating Author: Bradley Schmitz
Polymerase chain reaction (PCR) is ...

Gel Purification

Gel purification is used to recover DNA fragments after electrophoretic separation. DNA recovery from an agarose gel includes three basic steps: binding, ...

Detecting Reactive Oxygen Species

Reactive oxygen species are chemically active, oxygen-derived molecules capable of oxidizing other molecules. Because of their reactive nature, there are ...

Gene Silencing with Morpholinos

Morpholino-mediated gene silencing is a common technique used to study roles of specific genes during development. Morpholinos inhibit gene expression by ...

development-and-reproduction-of-the-laboratory-mouse

Development and Reproduction of the Laboratory Mouse

Successful breeding of the laboratory mouse (Mus musculus) is critical to the establishment and maintenance of a productive animal colony. Additionally, ...

Genetic Crosses

To dissect genetic processes or create organisms with novel suites of traits, scientists can perform genetic crosses, or the purposeful mating of two ...

Construct an explanation based on evidence for how the structure of DNA determines the structure of proteins which carry out the essential functions of life through systems of specialized cells.

HS-LS1-1.

Palpating the Thyroid for Goiter

Description

Transcript

Tags

More videos by Standards