Thyroid study

When examining the anterior surface of the neck, a pronounced enlargement of the thyroid gland (goiter) can be detected, sometimes leading to a sharp change in the configuration of the neck. In such cases, attention is paid to the symmetry of the enlargement of various parts of the thyroid gland.

The main clinical method for examining the thyroid gland is its palpation.

As is known, the thyroid gland lobes are covered in front by muscles that make their palpation difficult (in particular, the sternocleidomastoid muscle). It is generally accepted that the thyroid gland is not palpated in healthy people (especially men). However, some domestic and foreign authors believe that in some cases (in women, with a very thin neck) the thyroid gland can be palpated in a healthy person, which in such cases is felt as a soft ridge located in the area of the lateral surface of the thyroid cartilage. The normal size of the thyroid gland lobes does not exceed 3-6 cm in length, 3-4 cm in diameter, 1-2 cm in thickness.

There are 3 most common methods of palpating the thyroid gland.

In the first method of palpation, the doctor, located in front of the patient, deeply inserts the bent II-V fingers of both hands behind the posterior edges of the sternocleidomastoid muscles, and places the thumbs in the area of the thyroid cartilages inward from the anterior edges of the sternocleidomastoid muscles. During palpation, the patient is asked to swallow, as a result of which the thyroid gland moves upward together with the larynx and moves under the doctor's fingers. The isthmus of the thyroid gland is palpated on the anterior surface of the neck using sliding movements of the fingers in a vertical direction.

In the second method of palpation, the doctor is positioned to the right and slightly in front of the patient. To further relax the neck muscles, the patient slightly tilts his head forward. With his left hand, the doctor fixes the patient's neck, clasping it from behind. Palpation of the thyroid gland is performed with the fingers of the right hand, with the right lobe being palpated with the thumb, and the left lobe being palpated with the other fingers folded together.

In the third method of thyroid gland palpation, the doctor stands behind the patient. The thumbs are placed on the back of the neck, and the remaining fingers are placed on the area of the thyroid cartilages inward from the anterior edge of the sternocleidomastoid muscles. The doctor's palms are placed on the lateral surfaces of the neck in this method of palpation.

Having palpated the thyroid gland using one of the indicated methods, its size, surface, consistency, presence of nodes, mobility when swallowing, and soreness are determined.

To characterize the size of the thyroid gland, a classification has been proposed that provides for the identification of several degrees of its enlargement.

In cases where the thyroid gland is not palpable, it is customary to speak of its degree of enlargement as 0. If its isthmus is clearly palpable, it is considered to be degree I enlargement of the thyroid gland. With degree II enlargement, the lobes of the thyroid gland are easily palpated, and the thyroid gland itself becomes visible to the eye when swallowing. With degree III enlargement, the thyroid gland is already clearly visible during a routine examination ("thick neck"); such a thyroid gland is already called a goiter. With degree IV enlargement of the thyroid gland, the normal configuration of the neck changes dramatically. Finally, degree V enlargement of the thyroid gland is understood to mean a very large goiter.

With diffuse toxic goiter, the consistency of the thyroid gland can be soft or moderately dense, but its surface remains smooth.

Research of the endocrine system and the neuropsychic sphere

When thyroid nodes are detected by palpation, their number and consistency are determined. In the case of thyroid adenoma, it is often possible to palpate a node of dense elastic consistency, with clear boundaries and a smooth surface, mobile and not fused with the surrounding tissues. In the case of cancerous lesions of the thyroid gland, the palpable node becomes dense (sometimes - stony), loses the smoothness of its contours and mobility when swallowing. Pain during palpation of the thyroid gland is observed with its inflammatory changes (thyroiditis).

After palpation, the neck circumference is measured at the level of the thyroid gland. In this case, the centimeter tape is installed at the level of the spinous process of the 7th cervical vertebra at the back, and at the level of the most protruding area of the thyroid gland at the front. If individual nodes are detected, their diameter can be measured using a special caliper.

The percussion method can be used to detect a retrosternal goiter. In such cases, a shortened percussion sound is detected above the manubrium of the sternum.

During auscultation of the thyroid gland in patients with diffuse toxic goiter, it is sometimes possible to hear functional noise caused by increased vascularization of the thyroid gland and acceleration of blood flow in it in this disease.

Patients with diffuse toxic goiter often exhibit so-called eye symptoms. These include, in particular, Dalrymple's symptom (widening of the palpebral fissure with exposure of a strip of sclera above the iris), Stellwag's symptom (rare blinking), and Moebius's symptom (weakening of convergence). To determine Moebius's symptom, an object (pencil, fountain pen) is brought close to the patient's face and the patient is asked to fix his gaze on it. If convergence is insufficient, the patient's eyeballs involuntarily move to the sides.

Graefe's symptomconsists of the appearance of a strip of sclera between the upper eyelid and the iris when the eyeball moves downwards. When determining this symptom, the patient is also asked to look at an object that is moved in the direction from top to bottom. During the movement, it becomes noticeable how the patient's upper eyelid lags behind the movement of the eyeball.

Kocher's signis the appearance of the same strip of sclera between the upper eyelid and the iris when the eyeball moves upward, i.e. the eyeball lags behind the upper eyelid.