Goiter physical examination

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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

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

  • Exophthalmosis

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. [2] [3] [4]
  • 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. 1.0 1.1 Siderys H, Rowe GA (1970). "Superior vena caval syndrome caused by intrathoracic goiter". Am Surg. 36 (7): 446–50. PMID 4913941.
  2. 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.
  3. 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.
  4. 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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