Riedel's thyroiditis physical examination: Difference between revisions

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{{Riedel's thyroiditis}}
{{Riedel's thyroiditis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MMF}}


==Overview==
==Overview==
*Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical examination of patients with Riedel's thyroiditis is usually remarkable for hard [[Thyroid mass causes|thyroid mass]] and clinical signs of [[hypothyroidism]] such as [[fatigue]], [[bradycardia]], [[bradypnea]]. Patients may have the clinical signs of [[hypocalcemia]] such as positive [[Chvostek's sign|Chvostek sign]] and positive [[Trousseau sign]].
*Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical Examination==
==Physical Examination==


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
Physical examination of patients with Riedel's thyroiditis is usually remarkable for hard thyroid mass and clinical signs of [[hypothyroidism]] such as [[fatigue]], [[bradycardia]], [[bradypnea]]. Patients may have the clinical signs of [[hypocalcemia]] such as positive [[Chvostek's sign|Chvostek sign]] and positive [[Trousseau sign]].<ref name="urlThyroiditis — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra021194 |title=Thyroiditis — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid15298150">{{cite journal |vauthors=Papi G, LiVolsi VA |title=Current concepts on Riedel thyroiditis |journal=Am. J. Clin. Pathol. |volume=121 Suppl |issue= |pages=S50–63 |year=2004 |pmid=15298150 |doi= |url=}}</ref><ref name="pmid21832114">{{cite journal |vauthors=Hennessey JV |title=Clinical review: Riedel's thyroiditis: a clinical review |journal=J. Clin. Endocrinol. Metab. |volume=96 |issue=10 |pages=3031–41 |year=2011 |pmid=21832114 |doi=10.1210/jc.2011-0617 |url=}}</ref>
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
====Appearance of the Patient====
*Patients with [disease name] usually appear [general appearance].  
* Patients with Riedel's thyroiditis may appear [[Fatigue|fatigued]].


===Vital Signs===
===Vital Signs===
 
Patient may have:
*High-grade / low-grade fever
*[[Low-grade fever]]
*[[Hypothermia]] / hyperthermia may be present
*[[Bradycardia]]
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
*[[Cyanosis]]  
* [[Dry skin]]
*[[Jaundice]]
*Coarse hair
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
Patient may have:
* Evidence of trauma
*Positive [[Chvostek's sign|Chvostek sign]]
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
*[[Jugular venous distension]]
*Hard/fixed [[Thyroid mass causes|thyroid mass]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* Enlarged [[thyroid gland]] or presence of [[goiter]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* Small or shrunken [[thyroid gland]]  
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Respiratory===
*[[Abdominal distention]]  
*[[Bradypnea]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
* Slowed speech
* Altered mental status
* [[Reflexes|Slowed reflexes]]
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
*[[Clubbing]]  
*Positive [[Trousseau sign]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
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[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]

Latest revision as of 00:01, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Physical examination of patients with Riedel's thyroiditis is usually remarkable for hard thyroid mass and clinical signs of hypothyroidism such as fatigue, bradycardia, bradypnea. Patients may have the clinical signs of hypocalcemia such as positive Chvostek sign and positive Trousseau sign.

Physical Examination

Physical examination of patients with Riedel's thyroiditis is usually remarkable for hard thyroid mass and clinical signs of hypothyroidism such as fatigue, bradycardia, bradypnea. Patients may have the clinical signs of hypocalcemia such as positive Chvostek sign and positive Trousseau sign.[1][2][3]

Appearance of the Patient

  • Patients with Riedel's thyroiditis may appear fatigued.

Vital Signs

Patient may have:

Skin

HEENT

Patient may have:

Neck

Respiratory

Neuromuscular

Extremities

References

  1. ↑ "Thyroiditis — NEJM".
  2. ↑ Papi G, LiVolsi VA (2004). "Current concepts on Riedel thyroiditis". Am. J. Clin. Pathol. 121 Suppl: S50–63. PMID 15298150.
  3. ↑ Hennessey JV (2011). "Clinical review: Riedel's thyroiditis: a clinical review". J. Clin. Endocrinol. Metab. 96 (10): 3031–41. doi:10.1210/jc.2011-0617. PMID 21832114.

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