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PF Tiroid PDF
PF Tiroid PDF
PF Tiroid PDF
59 11
of the neck; the thickened mass moves upwards during examination include weight loss/weight gain, palpitation,
swallowing. Grade 1 includes also nodular goitre if thyroid alteration of bowel habits (diarrhea/constipation), sweating,
enlargement remains invisible. sleep problems, menstrual irregularities, growth problems,
• Grade 2 – neck swelling, visible when the neck is in normal delays in sexual maturation, infertility, hoarseness of voice,
position, corresponding to enlarged thyroid – found in exophthalmos, tremors, atrial fibrillation and thyroid gland
palpation.10 enlargement
Once the physical examination is complete, the physician • Investigations include serum T3, T4 and TSH for confirming
must plan the necessary investigations to confirm the diagnosis many of the thyroid diseases and for monitoring therapy
and plan treatment. The fact that almost all the investigations of hypo and hyperthyroidism, ultrasonography of thyroid
related to thyroid diseases are easily available put an additional and nuclear scan (hyperthyroidism).
responsibility on the Physician to select the appropriate and • A combination of right thinking, good history, thorough
cost effective tests in a given case. The measurement of thyroid physical examination and judicious use of investigations
hormones in the blood i.e. serum T3, T4 and TSH, is the most will sort out majority of thyroid problems in clinical practice.
helpful test in confirming many of the thyroid diseases and for
monitoring therapy of hypo and hyperthyroidism (Table 4). References
The isotope scan and uptake of thyroid is seldom needed in 1. Daniel GH. Physical Examination of the Thyroid. In Braverman
diagnosing and managing hypothyroidsim, where as they are LE, Utiger RD eds Werner and Ingbar’s the Thyroid: Philadelphia:
very useful in diagnosing and managing thyroid malignancy. Lippincot William’s & Wilkins, 2000: 462-66
Ultrasonography of thyroid has almost become part of clinical 2. Dillman WH. The Thyroid. In Goldman L, Bennett JC, eds Cecil Text
examination in many endocrine centers, but for our patients Book of Medicine. Philadelphia: WB Saunders, 2000: 12312-1249.
it is still an investigation to be ordered, when you want to get 3. Leonhardt JM, Heyman WR. Thyroid disease and the skin.
to know more about the nodules, their size, contents and the Dermatology Clinics 2002; 20: 471-81.
pressure effects. So by properly selecting the blood tests and 4. Larsen PR, Davies TF, Schlumberger MJ et al .Thyroid Physiology
imaging procedures in a suspected case, the physician will be and diagnostic evaluation of patients with thyroid disorders. In:
able to make a diagnosis in a given case Larsen PR, Kronberg HM, Melmed S et al. Ed Williams’s text book
It is important to remember that endocrine diseases evolve of Endocrinology. Philadelphia: WB Saunders, 2003: 364-5
very slowly and they may often be missed by a person who is 5. Gwinup G, Morton E. The high lying Thyroid: a cause of
seeing the patient regularly and is picked up by a physician pseudogoiter. J Clin Endocrinol Metab 1975; 40: 37-42
seeing the patient for the first time. Likewise, endocrine disease 6. Mercer RD. Pseudogoter: the Modigliani syndrome. Cleve Clin J
may have a more distant effect than local effects, and don’t expect Med 1975: 42:319-26.
the thyroid disease patient to present with neck problem always, 7. Siminoski K. The rational clinical examination: does this patient
except in subacute thyroiditis. So a combination of right thinking, have a goiter? JAMA 1995; 273: 813-7
good history, thorough physical examination and judicious use 8. Bickley LS, Hoekelman RA. The head and neck. In: Physical
of investigations will sort out majority of thyroid problems in Examination and history taking. Philadelphia: Lippincot, 1999:202-
your practice. 206,211, 244
9. Wartofsky L. Approach to the patient with thyroid disease.
Conclusion In: Becker KL, Ed Principles and practise of endocrinology.
Philadelphia: Lippincott Williams & Wilkins, 2001: 308
• A correct etiological, anatomical and functional diagnosis
10. WHO/UNICEF/ICCIDD. Chapter 2: Selecting target groups and
of the thyroid problem can be achieved by careful history, Chapter 5: Selecting appropriate indicators: Biochemical indicators.
thorough physical examination and by well-planned In: Indicators for Assessing Iodine Deficiency Disorders and
investigations their Control Through Salt Iodination. Geneva. World Health
• Pointers to thyroid disease on history and clinical Organization, WHO/NUT/94.6, 1994.