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. Denetim
<ol>
	<li>Hastanın başını hafifçe geriye doğru eğin ve ön boynunu dikkatlice inceleyin. Görünürse, tiroid krikoid kıkırdak ile suprasternal çentik arasında görünür. Simetri, yaygın şişlik ve belirgin kitleler olup olmadığını kontrol edin.</li>
	<li>Hastanın yutkunmasını sağlayın ve krikoid kıkırdak, tiroid kıkırdağı ve tiroid bezinin yukarı ve aşağı hareket ettiğini gözlemleyin.</li>
</ol>
2. Palpe
Tiroid ön veya arka pozisyonlardan palpe edilebilmesine rağmen, ikinci yaklaşım gelenekseldir.
<ol>
	<li>Sternomastoid kasları gevşetmek için hastadan boynunu hafifçe bükmesini isteyin.</li>
	<li>Hastanın arkasından, iki elinizle etrafa uzanın ve parmaklarınızı kullanarak yukarıdan aşağıya doğru yer işaretlerini belirleyin: mandibulanın hemen altındaki hareketli hyoid kemik, üst çentikli tiroid kıkırdağı, krikoid kıkırdak, trakeal halkalar ve suprasternal çentik.</li>
	<li>İşaret parmaklarınızı krikoid kıkırdağın hemen altına yerleştirin.</li>
	<li>Hastadan daha önce olduğu gibi yutkunmasını isteyin ve parmak uçlarınızın altında yükselen tiroid istmusunu hissedin. Her zaman elle tutulur değildir. Herhangi bir nodül veya hassasiyete dikkat ederek boyut, şekil ve kıvamı hissedin.</li>
	<li>Sağ elinizin parmaklarını kullanarak trakeayı yavaşça sola doğru hareket ettirin ve trakea ile sternomastoid kas arasındaki boşlukta sağ lobu hissedin.</li>
	<li>Benzer şekilde sol lobu da inceleyin.</li>
	<li>Guatr tespit edilirse, stetoskopu yan lobların üzerine yerleştirerek çürük olup olmadığını dinleyin.</li>
</ol>

Büyümüş bir tiroid bezi veya guatr, çoğunlukla normal tiroid bezi fonksiyonu (ötiroid) ile ilişkilidir, ancak hiper veya hipotiroidi durumlarıyla ilişkili olabilir. Bu nedenle, fizik muayenede bulunan tiroid anormalliği, hem yüksek hem de düşük tiroid hormon seviyeleri ile ilişkili sistemik belirti ve semptomlar için dikkatli bir değerlendirme gerektirmelidir. Normal bir tiroidin palpe edilmesi, özellikle büyük boyunlu hastalarda zor olabilir. Bununla birlikte, yakındaki kemikli ve kıkırdaklı yer işaretleri tanımlanarak ...

tiroid muayenesi

Kaynak: Richard Glickman-Simon, MD, Yardımcı Doçent, Halk Sağlığı ve Toplum Hekimliği Anabilim Dalı, Tufts Üniversitesi Tıp Fakültesi, MA
Tiroid bezi boyun ön trakeasında krikoid kıkırdak (yukarıda) ile suprasternal çentik (altta) arasında yer alır (Şekil 1). Bir kıstakla birbirine bağlanan bir sağ ve sol lobdan oluşur. Kıstak ikinci, üçüncü ve dördüncü trakeal halkaları kaplar ve loblar trakea ve yemek borusunun kenarlarında arkaya doğru kıvrılır. 10 - 25 g ağırlığındaki normal bez, muayenede genellikle görünmez ve genellikle palpe edilmesi zordur. Guatr, herhangi bir nedenden dolayı genişlemiş bir tiroiddir. Boyutunu değerlendirmenin yanı sıra, tiroidi şekli, hareketliliği, kıvamı ve hassasiyeti açısından palpe etmek önemlidir. Normal bir tiroid yumuşak, pürüzsüz, simetrik ve hassas değildir ve yutulduğunda hafifçe yukarı doğru kayar. Yumuşak, pürüzsüz bir tiroidin simetrik büyümesi, iyot eksikliğine veya iki yaygın otoimmün bozukluktan birine bağlı endemik hipotiroidizmi düşündürür: Graves hastalığı veya Hashimoto tiroiditi. Tiroid nodülleri sık görülür ve genellikle tesadüfidir; Ancak tiroid nodüllerinin 'u kötü huylu çıkıyor. Tek veya çoklu olabilirler ve çoğunlukla sağlamdırlar ve hassas değildirler. Hassas, simetrik bir guatr tipik olarak tiroiditi gösterir.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg"> 
Şekil 1. Tiroid bezinin anatomisi. Tiroid bezinin boyun yapılarına göre yeri ve anatomisinin gösterimi.
Tiroid hastalığı nadiren tek başına ele gelen bir guatr olarak kendini gösterir. Tiroid hormonları, öncelikle vücuttaki hücresel metabolizmayı uyararak homeostazı korumaya hizmet eder. Bu nedenle, hipo ve hipertiroidizm bir dizi semptom ve fiziksel bulgu ile ilişkilidir (Tablo 1). Guatrların ötiroid (normal tiroid hormon seviyeleri), hipertiroid veya hipotiroid olabileceğine dikkat etmek önemlidir. Baş ağrısı veya görme bozuklukları, hipofiz adenomuna bağlı ikincil bir tiroid bozukluğunu düşündürebilir
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg">
Tablo 1. Hipo ve hipertiroidizm için semptomlar ve fiziksel bulgular.

Tiroid Muayenesi

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

Klinik Beceriler

Physical Examinations II

Fiziksel Muayeneler 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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Bu koleksiyon, HEENT muayeneleri, abdominal muayeneler ve pelvik muayeneler gibi daha hassas ve kapsamlı fiziksel muayenelerle ilişkili metodolojileri ve prosedürleri içeren özel bir baskıdır.

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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