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==Overview==
==Overview==
Physical examination of patients with Goiter is usually remarkable for swelling at the base of the neck.
Physical examination of patients with goiter is usually remarkable for swelling at the base of the neck.


==Physical Examination==
==Physical Examination==
Physical examination of patients with Goiter is usually remarkable for swelling at the base of the neck. <ref name="pmid28862050">{{cite journal| author=Brandehoff N, Adams A, McDaniel K, Banister SD, Gerona R, Monte AA| title=Synthetic cannabinoid "Black Mamba" infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort. | journal=Clin Toxicol (Phila) | year= 2017 | volume=  | issue=  | pages= 1-6 | pmid=28862050 | doi=10.1080/15563650.2017.1357826 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28862050  }} </ref> <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="pmid28862050">{{cite journal| author=Brandehoff N, Adams A, McDaniel K, Banister SD, Gerona R, Monte AA| title=Synthetic cannabinoid "Black Mamba" infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort. | journal=Clin Toxicol (Phila) | year= 2017 | volume=  | issue=  | pages= 1-6 | pmid=28862050 | doi=10.1080/15563650.2017.1357826 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28862050  }} </ref><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 Patient===
===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 Signs===
===Vital Signs===
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===HEENT===
===HEENT===
*Exophthalmosis
*[[Exophthalmos]]


===Neck===
===Neck===
*[[Jugular vein compression]] or [[thrombosis]] (Rare) <ref name="pmid4913941">{{cite journal |vauthors=Siderys H, Rowe GA |title=Superior vena caval syndrome caused by intrathoracic goiter |journal=Am Surg |volume=36 |issue=7 |pages=446–50 |year=1970 |pmid=4913941 |doi= |url=}}</ref>
*Jugular vein compression or [[thrombosis]] (rare) <ref name="pmid4913941">{{cite journal |vauthors=Siderys H, Rowe GA |title=Superior vena caval syndrome caused by intrathoracic goiter |journal=Am Surg |volume=36 |issue=7 |pages=446–50 |year=1970 |pmid=4913941 |doi= |url=}}</ref>
*[[Superior vena cava syndrome]] (Rare) <ref name="pmid4913941">{{cite journal |vauthors=Siderys H, Rowe GA |title=Superior vena caval syndrome caused by intrathoracic goiter |journal=Am Surg |volume=36 |issue=7 |pages=446–50 |year=1970 |pmid=4913941 |doi= |url=}}</ref>
*[[Superior vena cava syndrome]] (rare) <ref name="pmid4913941">{{cite journal |vauthors=Siderys H, Rowe GA |title=Superior vena caval syndrome caused by intrathoracic goiter |journal=Am Surg |volume=36 |issue=7 |pages=446–50 |year=1970 |pmid=4913941 |doi= |url=}}</ref>


===Lungs===
===Lungs===
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===Heart===
===Heart===
*Normal S1 and S2.
*Normal S1 and S2


===Abdomen===
===Abdomen===
*Normal abdominal findings.
*Normal abdominal findings


===Back===
===Back===
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====Pemberton's sign====
====Pemberton's sign====
*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>
*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

Revision as of 20:59, 20 September 2017

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

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][3]

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

  • Moist skin

HEENT

Neck

Lungs

  • Normal vesicular breath sounds
  • Wheeze may be present as a result of compression of the gland over the trachea
  • Tracheal deviation or compression may be seen in some cases
  • Stridor may be seen in some cases

Heart

  • Normal S1 and S2

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.[5][6][7]
  • 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
    • Cyanosis
    • Distress
  • Vascular engorgement and facial congestion imply the impaired venous outflow from the head and neck
  • Tracheal compromise may also be observed
  • Venous thrombosis has also been seen in few cases

References

  1. ↑ Brandehoff N, Adams A, McDaniel K, Banister SD, Gerona R, Monte AA (2017). "Synthetic cannabinoid "Black Mamba" infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort". Clin Toxicol (Phila): 1–6. doi:10.1080/15563650.2017.1357826. PMID 28862050.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 4.0 4.1 Siderys H, Rowe GA (1970). "Superior vena caval syndrome caused by intrathoracic goiter". Am Surg. 36 (7): 446–50. PMID 4913941.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.

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