Thyroid – History Taking

- Dr. Ankit Chandra

1. Patient details
• Name –
• Age –
• Gender - male/female
• Occupation –
• Educated up to –
• Hailing from (address) – *Endemic goiter
2. Chief complain
• Swelling in front/side (rt/left) of the Neck for ____ months /years
• Pain over the swelling for ____ months /years
• Hoarseness of voice for ____
• Difficulty in swallowing/breathing for___
• Bulging of eyes
3. History of presenting illness (HOPI)
• Patient was apparently well ___ months back , when she noticed a swelling in
the neck while taking bathe/etc .
OR
• Patient was diagnosed with thyroid cancer 2 years back and underwent thyroid
surgery (hemi-thyroidectomy) , now again patient have presented with neck
swelling for past 1 month
3a) History of swelling
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
• Onset – sudden/insidious
• Site – front /side of the neck
• Duration –
• Rate of growth/ progress in size – gradual(benign) / Rapid inc.(malignant)
• Associated with pain ?
3b) H/O pain
• Duration & site -
• Nature of pain – usually dull aching
• Any Radiation ? –
• Aggravating Factor -
• Relieving Factor –
• Associated with fever ?
3c) History of pressure effects
• Dyspnea / stridor
• Dysphagia
• Hoarseness of voice
• Syncope
History of Thyrotoxicosis
- Excessive sweating
- Loss of weight in spite of good appetite
- Heat tolerance
- Diarrhea
- Amenorrhea (dec. Menstruation )
History of Primary Thyrotoxicosis
• CNS – Tremor of hands, Insomnia , Sleepless nights , Proximal muscle weakness
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
(difficulty in climbing stairs/ difficulty in standing from sitting position)
• EYE – exophthalmos, difficulty in closing eyes , Double vision (opthalmoplegia), Pain
• CVS symptoms may not be pronounce
History of Secondary Thyrotoxicosis
• Mainly CVS – palpitation , ectopic beats , arrhythmia , dyspnea, Chest pain, Edema of ankle,
Congestive Cardiac failure
• CNS & Eye symptoms may be mild or absent
History of Hypothyroidism
• increase in weight despite of Decrease in appetite
• Hoarseness of voice due to edema of vocal cords
• Falling hair , 2/3rd of eyebrow may fall off
• Constipation
• Weakness / Lethargy
• Swelling of face/legs/body
• Cold Intolerance , dry skin
• Menorrhagia followed later by Amenorrhea (due to anemia)
History of Malignancy & Metastasis
• Weight loss & loss of appetite
• Bone – Bone pain
• Lung – Dyspnea , cough with hemoptysis
• Brain(*papillary ca) – seizure , neurological deficit
• Skull *Follicular Ca.
H/o Bulging of eyes
• Duration
• Progress
• H/o redness of eye & watering
• H/o double vision
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
• Loss of vision
3. Past History
• H/O treatment of thyroid disorder -
• H/O DM/ HTN / CAD _____ for how many years ? On which medications?
• H/o asthma / TB/ epilepsy
• History of previous surgery (*reoccurrence)
• History of irradiation in childhood
• History of longstanding MNG
4. Family history
• Goitre ? *Endemic
• Thyroid Cancer
• Medullary carcinoma of thyroid
• Multiple endocrine neoplasia (MEN IIa, IIb)
5. Personal History
• Diet - consuming excessive Goitrogens -Brassica family(cabbage,kale)
• Habit of sea fish , low iodine - goiter
• Any allergy to any drugs ?
• Bowel habits -(*diarrhea in medullary Ca of thyroid/hyperthyrotoxicosis)
• Drug intake – Lithium, thyroxine, antithyroid drugs, amiodarone
• Goitrogenic drugs – lithium , sulphonilurea , PAS, antithyroid drugs
6. Summary of History
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
• ____ old lady presented with a swelling in right/left side of the neck for past ___months
with rapid/slow increase in size. Not associated with pain. No h/o Pressure symptoms . No
history suggestive of hypo or hyperthyroidism.

Thyroid – Examination
- Dr. Ankit Chandra
1) General Examination
• Comfortable at rest
• Conscious , co-operative
• Oriented to time , Place & Person
• Built (skeletal parameter) - moderate
• Nourishment (BMI based) - average/poor
• BMI = weight (kg) / ht in (mt)2
• Pallor , icterus , cyanosis , clubbing , pedal odema , lymphadenopathy
*Mask Like Facies – Hypothyroidism
*facial expression of excitement/tension/nervousness - Hyperthyroidism
* Clinical features of hypo/hyperthyroidism
2. Vitals – BP , Pulse , RR , temp , SPO2
3. Other system examination
Cardio-vascular System (CVS)
• Heart Rate & Rhythm-
• Heart sounds- S1 & S2
• Additional sounds – murmur, rub, gallop
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
Respiratory system (RS)
• Normal Breath sounds-
• Additional sounds
• Clear to percussion
• Tenderness to palpation
Abdominal Examination
• Any Mass in abdomen ?
• Any organo-megaly ?
• Pelvis
4) Local examination
4a) Inspection -
• Swelling Number / lobe enlarged
• Site -
• Size –
• Shape – butterfly(B/L lobe+isthmus)/Hemispherical (solitary)
• Extent -
• Surface – smooth(adenoma,grave)/ irregular(carcinoma) / nodular (MNG)
• All the margins visible ? *especially Lower border of swelling ?
• Any change of Skin over the swelling ? – scar/pigmentation
• Any visible pulsation ?
• Any Dilated veins ? /venous prominence
• Moves with Deglutition or Not ?
• Movement with protrusion of tongue or not ?
• On stretching the deep fascia by extending the neck, does swelling become more
prominent ?
4b) Palpation
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
• Local warmth & tenderness
• Swelling Number & Site -
• Size –
• Extent -
• Surface – smooth (colloid goiter, Grave’s disease )
- Bosselated (MNG)
• Consistency – soft (colloid goiter, Grave’s disease )
- Firm (SNG , MNG, hashimoto, primary thyrotoxicosis)
- Hard (carcinoma , Riedel’s Thyroiditis)
- variegated
• Mobility – Mobile vertically/ restricted (Carcinoma & chronic thyroiditis), fixity to skin ?
• Strenocleidomastoid contraction test
Palpation for Pressure symptoms
- Kocher’s test
- Palpation of carotid artery
- Berry’s sign
• Test To discard the possibility of retrosternal extension
• Palpate for Trachea & its position
• Palpation of Cervical lymph nodes
• Measurement of circumference of neck
4C) Percussion
• Over manubrium
4D) Auscultation
any bruit in superior pole ?
THYROID HISTORY & EXAMINATION | Dr. Ankit Chandra
• Examine for Metastasis
Spine
Cranium
Lung
Ends of long bone
6) Diagnosis
1. Anatomical Diagnosis – SNG / MNG / Diffuse Goiter
2. Functional Diagnosis – Toxic / Euthyroid / Hypothyroid
3. Pathological Diagnosis – Benign / Malignant(LN palpable)
Example –
This is a case of non-toxic multinodular goiter involving both the lobes and isthmus of the
thyroid
gland