Quick Review: Examination of the Thyroid

00:01 Okay, let's review some of what we've learned.

00:04 For the thyroid exam, in particular, we're looking for some of those findings that go along with hyperthyroidism causes and then hypothyroidism causes.

00:12 So just honing in on a few particular boxes in this chart with graves disease, which of course has its own unique features independent of the increased sympathetic tone that accompanies hyperthyroidism.

00:24 You might be looking for a diffuse enlargement of the thyroid, though it may be soft in texture, and of course, your lab values would have a low TSH and a high T4.

00:33 We'd be looking for exophthalmos in terms of the eye exam and potentially pretibial myxedema down in the legs.

00:40 In contrast, with hashimoto's thyroiditis which is the most common cause of hypothyroidism, in adults, men and women, the size of the thyroid can be variable, but the texture should be more of a firm type with some fibrotic changes happening due to the chronic lymphocytic infiltration of the thyroid.

01:00 You can see the lab values there would be the opposite of what we saw with hyperthyroidism.

01:05 And some of those classic manifestations of hypothyroidism that we've talked about with bradycardia and hung reflexes, for example.

01:13 And multinodular goiter may have no changes to the lab values at all, but you'd have a slightly enlarged thyroid gland with potentially palpable nodules one or many in number.

01:29 So which of the following might be seen with hypothyroidism? Smooth sweaty skin, Delayed relaxation phase of the deep tendon reflexes Lid lag, pretibial myxedema, or Exophthalmos.

01:48 So with hypothyroidism we have decreased sympathetic tone.

01:52 So actually less sweating.

01:54 So smooth sweaty skin would not be something we would see with hypothyroidism.

01:59 In contrast, delayed relaxation phase of deep tendon reflexes, so called hung reflexes is a characteristic feature of hypothyroidism.

02:07 Lid lag is something we see with the increased sympathetic tone of hyperthyroidism.

02:11 Pretibial myxedema is typically seen with graves disease because of that mucopolysaccharide deposition in the pretibial regions of the shins and the exophthalmos also is part of graves disease with that polysaccharide deposition in the ocular muscles that are pushing the eyeballs forward.