Goiter physical examination: Difference between revisions
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[[Physical examination]] of patients with goiter is usually remarkable for [[swelling]] at the base of the [[neck]].<ref name="pmid18664541">{{cite journal| author=Bonnema SJ, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Bastholt L et al.| title=Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration. | journal=J Clin Endocrinol Metab | year= 2008 | volume= 93 | issue= 10 | pages= 3981-4 | pmid=18664541 | doi=10.1210/jc.2008-0485 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18664541 }} </ref><ref name="pmid20823469">{{cite journal| author=Jukić T, Kusić Z| title=Image in endocrinology. Pemberton's sign in patient with substernal goiter. | journal=J Clin Endocrinol Metab | year= 2010 | volume= 95 | issue= 9 | pages= 4175 | pmid=20823469 | doi=10.1210/jc.2010-0944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20823469 }} </ref> | [[Physical examination]] of patients with goiter is usually remarkable for [[swelling]] at the base of the [[neck]].<ref name="pmid18664541">{{cite journal| author=Bonnema SJ, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Bastholt L et al.| title=Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration. | journal=J Clin Endocrinol Metab | year= 2008 | volume= 93 | issue= 10 | pages= 3981-4 | pmid=18664541 | doi=10.1210/jc.2008-0485 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18664541 }} </ref><ref name="pmid20823469">{{cite journal| author=Jukić T, Kusić Z| title=Image in endocrinology. Pemberton's sign in patient with substernal goiter. | journal=J Clin Endocrinol Metab | year= 2010 | volume= 95 | issue= 9 | pages= 4175 | pmid=20823469 | doi=10.1210/jc.2010-0944 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20823469 }} </ref> | ||
===Appearance of the | ===Appearance of the patient=== | ||
*Patients with goiter usually appear with a cosmetic distortion of the [[neck]] along with a [[lump]] at the base of the [[neck]] and are asymptomatic in general. | *Patients with goiter usually appear with a cosmetic distortion of the [[neck]] along with a [[lump]] at the base of the [[neck]] and are [[asymptomatic]] in general. | ||
===Vital | ===Vital signs=== | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
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===Lungs=== | ===Lungs=== | ||
*Normal vesicular [[breath sounds]] | *Normal [[Vesicular breathing|vesicular]] [[breath sounds]] | ||
*[[Wheeze]] may be present as a result of compression of the [[thyroid gland]] over the [[trachea]] | *[[Wheeze]] may be present as a result of compression of the [[thyroid gland]] over the [[trachea]] | ||
*[[Tracheal deviation]] or compression may be seen in some cases | *[[Tracheal deviation]] or compression may be seen in some cases | ||
| Line 34: | Line 34: | ||
===Heart=== | ===Heart=== | ||
*Normal [[S1]] and [[S2]] | *Normal [[S1]] and [[S2]] | ||
*No rubs or gallop | |||
===Abdomen=== | ===Abdomen=== | ||
| Line 51: | Line 52: | ||
====Pemberton's sign==== | ====Pemberton's sign==== | ||
*While clinically evaluating an [[enlarged thyroid gland]], [[ | *While clinically evaluating an [[enlarged thyroid gland]], [[Pemberton's sign]] is observed.<ref name="pmid24646105">{{cite journal| author=De Filippis EA, Sabet A, Sun MR, Garber JR| title=Pemberton's sign: explained nearly 70 years later. | journal=J Clin Endocrinol Metab | year= 2014 | volume= 99 | issue= 6 | pages= 1949-54 | pmid=24646105 | doi=10.1210/jc.2013-4240 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24646105 }} </ref><ref name="pmid15044645">{{cite journal| author=Basaria S, Salvatori R| title=Images in clinical medicine. Pemberton's sign. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 13 | pages= 1338 | pmid=15044645 | doi=10.1056/NEJMicm990287 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15044645 }} </ref><ref name="pmid9385120">{{cite journal| author=Anders H, Keller C| title=Pemberton's maneuver - a clinical test for latent superior vena cava syndrome caused by a substernal mass. | journal=Eur J Med Res | year= 1997 | volume= 2 | issue= 11 | pages= 488-90 | pmid=9385120 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9385120 }} </ref> | ||
*[[Pemberton's sign]] is observed when both arms are elevated until the arms align with the side of the head. Usually in a minute of doing so, this elicits: | *[[Pemberton's sign]] is observed when both arms are elevated until the arms align with the side of the head. Usually in a minute of doing so, this elicits: | ||
**Congestion of [[face]] | **Congestion of [[face]] | ||
**[[Cyanosis]] | **[[Cyanosis]] | ||
**[[Distress]] | **[[Distress]] | ||
*Vascular engorgement and facial [[congestion]] imply the impaired venous outflow from the [[head]] and [[neck]] | *[[Vascular]] engorgement and facial [[congestion]] imply the impaired [[venous]] outflow from the [[head]] and [[neck]] | ||
*[[Trachea|Tracheal]] | *[[Trachea|Tracheal]] compression may also be observed | ||
*[[Venous thrombosis]] has also been seen in few cases | *[[Venous thrombosis]] has also been seen in few cases | ||
Latest revision as of 18:44, 17 November 2017
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Goiter Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Goiter physical examination On the Web |
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American Roentgen Ray Society Images of Goiter physical examination |
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Risk calculators and risk factors for Goiter physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]
Overview
Physical examination of patients with goiter is usually remarkable for swelling at the base of the neck.
Physical Examination
Physical examination of patients with goiter is usually remarkable for swelling at the base of the neck.[1][2]
Appearance of the patient
- Patients with goiter usually appear with a cosmetic distortion of the neck along with a lump at the base of the neck and are asymptomatic in general.
Vital signs
Skin
HEENT
Neck
- Jugular vein compression or thrombosis (rare) [3]
- Superior vena cava syndrome (rare) [3]
Lungs
- Normal vesicular breath sounds
- Wheeze may be present as a result of compression of the thyroid gland over the trachea
- Tracheal deviation or compression may be seen in some cases
- Stridor may be seen in some cases
Heart
Abdomen
- Normal abdominal findings
Back
- Normal findings observed
Genitourinary
- Normal findings observed
Neuromuscular
Extremities
- Normal findings observed
Pemberton's sign
- While clinically evaluating an enlarged thyroid gland, Pemberton's sign is observed.[4][5][6]
- Pemberton's sign is observed when both arms are elevated until the arms align with the side of the head. Usually in a minute of doing so, this elicits:
- Vascular engorgement and facial congestion imply the impaired venous outflow from the head and neck
- Tracheal compression may also be observed
- Venous thrombosis has also been seen in few cases
References
- ↑ Bonnema SJ, Nielsen VE, Boel-Jørgensen H, Grupe P, Andersen PB, Bastholt L; et al. (2008). "Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration". J Clin Endocrinol Metab. 93 (10): 3981–4. doi:10.1210/jc.2008-0485. PMID 18664541.
- ↑ Jukić T, Kusić Z (2010). "Image in endocrinology. Pemberton's sign in patient with substernal goiter". J Clin Endocrinol Metab. 95 (9): 4175. doi:10.1210/jc.2010-0944. PMID 20823469.
- ↑ 3.0 3.1 Siderys H, Rowe GA (1970). "Superior vena caval syndrome caused by intrathoracic goiter". Am Surg. 36 (7): 446–50. PMID 4913941.
- ↑ De Filippis EA, Sabet A, Sun MR, Garber JR (2014). "Pemberton's sign: explained nearly 70 years later". J Clin Endocrinol Metab. 99 (6): 1949–54. doi:10.1210/jc.2013-4240. PMID 24646105.
- ↑ Basaria S, Salvatori R (2004). "Images in clinical medicine. Pemberton's sign". N Engl J Med. 350 (13): 1338. doi:10.1056/NEJMicm990287. PMID 15044645.
- ↑ Anders H, Keller C (1997). "Pemberton's maneuver - a clinical test for latent superior vena cava syndrome caused by a substernal mass". Eur J Med Res. 2 (11): 488–90. PMID 9385120.