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. Осмотр
<ol>
	<li>Слегка запрокиньте голову пациента назад, и внимательно осмотрите переднюю часть шеи. Если она видима, щитовидная железа появляется между перстневидным хрящом и надгрудинной выемкой. Проверьте симметрию, диффузный отек и явные массы.</li>
	<li>Дайте пациенту проглотить и наблюдайте, как перстневидный хрящ, щитовидный хрящ и щитовидная железа двигаются вверх и вниз.</li>
</ol>
2. Пальпация
Хотя щитовидная железа может пальпироваться как спереди, так и сзади, последний подход является традиционным.
<ol>
	<li>Попросите пациента слегка согнуть шею, чтобы расслабить грудино-сосцевидные мышцы.</li>
	<li>Сзади пациента протяните обе руки и пальцами определите ориентиры сверху вниз: подвижная подъязычная кость прямо под нижней челюстью, щитовидный хрящ с его верхней выемкой, перстневидный хрящ, трахеальные кольца и надгрудинная выемка.</li>
	<li>Поместите указательные пальцы чуть ниже перстневидного хряща.</li>
	<li>Попросите пациента глотать, как и раньше, и нащупайте щитовидный перешеек, поднимающийся вверх под подушечками пальцев. Она не всегда ощутима. Нащупайте размер, форму и консистенцию, отмечая любые узелки или болезненность.</li>
	<li>Пальцами правой руки осторожно сдвиньте трахею влево и нащупайте правую долю в пространстве между трахеей и грудино-сосцевидной мышцей.</li>
	<li>Аналогичным образом осмотрите левую долю.</li>
	<li>При обнаружении зоба прислушайтесь к шуму, поместив стетоскоп на боковые доли.</li>
</ol>

Увеличенная щитовидная железа, или зоб, чаще всего связана с нормальной функцией щитовидной железы (эутиреоз), но может быть связана с гипер- или гипотиреозом. Таким образом, аномалия щитовидной железы, обнаруженная при физикальном осмотре, должна побудить к тщательной оценке системных признаков и симптомов, связанных как с высоким, так и с низким уровнем гормонов щитовидной железы. Нормальная щитовидная железа может быть затруднена для пальпации, особенно у пациентов с большой шеей. Тем не менее, его местоположение можн...

Обследование щитовидной железы

Источник: Ричард Гликман-Саймон, доктор медицинских наук, доцент кафедры общественного здравоохранения и общественной медицины, Медицинская школа Университета Тафтса, Массачусетс
Щитовидная железа расположена в передней трахее шеи между перстневидным хрящом (вверху) и надгрудинной выемкой (внизу) (рис. 1). Он состоит из правой и левой долей, соединенных перешейком. Перешеек охватывает второе, третье и четвертое кольца трахеи, а доли изгибаются кзади вокруг боков трахеи и пищевода. Нормальная железа, весом 10 - 25 г, обычно незаметна при осмотре и часто с трудом поддается пальпации. Зоб – это увеличение щитовидной железы по любой причине. Помимо оценки ее размера, важно пальпировать щитовидную железу на предмет ее формы, подвижности, консистенции и болезненности. Нормальная щитовидная железа мягкая, гладкая, симметричная и неболезненная, при глотании она слегка скользит вверх. Симметричное увеличение мягкой, гладкой щитовидной железы указывает на эндемический гипотиреоз из-за дефицита йода или одно из двух распространенных аутоиммунных заболеваний: болезнь Грейвса или тиреоидит Хашимото. Узлы щитовидной железы распространены и обычно случайны; Однако 10% узлов щитовидной железы оказываются злокачественными. Они могут быть одиночными или множественными, чаще всего твердыми и нежными. Болезненный, симметричный зоб обычно указывает на тиреоидит.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> 
Рисунок 1. Анатомия щитовидной железы. Иллюстрация расположения и анатомии щитовидной железы по отношению к структурам шеи.
Заболевание щитовидной железы редко проявляется в виде пальпируемого зоба изолированно. Гормоны щитовидной железы служат для поддержания гомеостаза в первую очередь за счет стимуляции клеточного метаболизма во всем организме. Таким образом, гипо и гипертиреоз связаны с рядом симптомов и физикальных находок (Таблица 1). Важно отметить, что зоб может быть эутиреоидным (нормальный уровень гормонов щитовидной железы), гипертиреозным или гипотиреозным. Головные боли или нарушения зрения могут указывать на вторичное заболевание щитовидной железы из-за аденомы гипофиза
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
Таблица 1. Симптомы и физикальные данные при гипо- и гипертиреозе.

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

Клинические навыки

Physical Examinations II

Физикальный осмотр 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

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Inspection and Palpation

Summary

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HS-LS1-1.

Palpating the Thyroid for Goiter

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