Palpation Of The Thyroid Gland

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Palpation of the thyroid gland

Content:

• Palpation techniques
• What is assessed by palpation
• Thyroid enlargement
• What should you pay attention to?
• Palpation signs of goiter

Palpation of an organ is palpation of it with fingers and palms in order to obtain information about the state of tissues, swelling, increase or decrease in size, pain. The same applies to palpation of the thyroid gland.

The patient should be prepared that during the examination the doctor will begin to feel his neck - this is a standard medical practice.

Palpation techniques

Each doctor has his own developed methods of palpation research, which have been developed over the years of medical practice, which means that they will be as informative as possible for the doctor. He can palpate the organ with one hand or with both, or even with just a few fingers - it all depends on the characteristics of the gland, its consistency, pain, etc. He can stand or sit directly opposite the patient or stand behind his back.

Palpation examination is performed in stages - superficial and deep palpation. During this time, the patient needs to sit or stand. The doctor makes a superficial examination with his right hand - with his fingers, a sliding soft movement is made from the cartilage in the middle part to the jugular notch. With his left hand the doctor holds the patient by the back of the head.

During deep palpation, the doctor works with both thumbs. He places them in front of the surface of both lobes. With other fingers, he wraps around the neck in a half ring. To palpate the isthmus, the doctor makes sliding movements with his thumb along the midline.

What is assessed by palpation of the thyroid gland

• Dimensions, with an enlarged gland - a characteristic of the state of the tissues of the gland;

• Consistency - tight elastic, soft elastic;
• Rough or smooth surface;
• Identification of nodular neoplasms;
• Soreness to touch;
• Identification of pathological pulsation.

What is the norm?

Normally, the thyroid gland is almost undetectable; on palpation, it can be determined that the consistency is soft-elastic, the surface is smooth, the structure is homogeneous.

Enlargement of the thyroid gland in size - goiter (hyperplasia)

In Russia, there are two classifications for assessing the degree of hyperplasia.

One of them was developed in 1955 by O. O. Nikolev, who proposed to classify the magnitude of the increase in several degrees:

• Zero - the state of the gland is normal, it is not palpable and not visible during examination;
• First, it is possible to determine the isthmus during swallowing;
• The second - the gland becomes visible due to the increase in size;
• The third is the thick neck stage. The thyroid gland becomes visible due to an increase in the size of both lobes and the isthmus. Palpation reveals heterogeneity of the structure, diffuse hyperplasia, nodular neoplasms;
• Fifth - a significant increase in size, the formation of a goiter.

An increase in I and II degrees without impairment of function can be considered the norm.

The generally accepted world classification of WHO provides for the division of the stages of hyperplasia into only two degrees:

• 0 - no goiter;
• I - visual increase is not detected. Palpation reveals an increase greater than the length of the phalanx;
• II - goiter can be detected both by visual examination and during palpation.

What should you pay attention to?

Often, patients are the first to notice signs of change and then seek medical help.

Signs not to be ignored:

• During swallowing, the gland begins to move along with the larynx or remains completely motionless in some diseases;
• Styrous (noisy) breathing caused by pressure on the larynx by an enlarged gland, or enlarged nodes;
• Paresis of the vocal cords contributes to the development or enhancement of hoarseness;

• Pressing the enlarged gland on the esophagus leads to the development of dysphagia - the appearance of belching, hiccups, and other unpleasant sensations.

Palpable signs of goiter in certain diseases of the thyroid gland

The consistency of the goiter can be diffuse, nodular or mixed. Against the background of hyperplasia of the thyroid gland, its functional state can be assessed as euthyroidism (normal), hypothyroidism (hormone production is lowered), hyperthyroidism (hormone production is increased).

• Diffuse toxic goiter. Hyperplasia of the gland with an increase in hormonal levels, signs of thyrotoxicosis. On palpation, the gland is enlarged to the second-fifth degree, soft or (rarely) densely elastic consistency, sometimes you can hear a systolic murmur during auscultation of the gland.
• Endemic goiter occurs against the background of iodine deficiency. It is diagnosed mainly in people living in areas characterized by a low iodine content in food and water. It can be of any consistency - diffuse, nodular or mixed.

Diffuse goiter - a uniform increase in the size of the gland, local seals are not found. Nodular goiter is characterized by a defined tumor-like neoplasm in the form of a dense nodule. The size of the gland itself is not enlarged. The mixed type is characterized by a combination of an enlarged gland and the presence of a node.

• Thyroiditis is an inflammation of the gland. Several types of this condition have been identified: autoimmune thyroiditis, subacute de Curwen's thyroiditis, etc. Palpation determines the enlargement of the gland in size, the consistency is lobular-elastic, dense, unconnected with the skin, the surface is bumpy, painful when touched, you can determine the symptom of swinging (pressure one beat makes the other wiggle). Riedel's fibrous thyroiditis is characterized by connective tissue proliferation in the gland, which is enlarged unevenly, of dense consistency to "woodiness", the surface is bumpy, painful when touched, sometimes soldered to other tissues.
• Nodular euthyroid goiter. A dense node is palpated in the tissues of a healthy gland.

This disease needs differential diagnosis to exclude thyroid adenoma or cancer. Cancer is characterized by little or no mobility. The gland is closely connected with other tissues, the cervical lymph nodes are enlarged.

The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist

Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).