Assessment of Neck Structures and Thyroid Disorders

What do you look for when doing a general inspection of the neck?

✓Asymmetry

✓Masses

✓Scars - Surgical* or traumatic

✓Enlarged parotid or submandibular glands

✓Visible lymph nodes

What lymph node groups do you palpate during a neck examination?

1. Pre-auricular

2. Posterior auricular

3. Occipital

4. Tonsillar

5. Submandibular

6. Sub-mental

7. Superficial cervical

8. Posterior cervical

9. Deep cervical chain

10. Supraclavicular

What are you evaluating when palpating lymph nodes?

1. Size

2. Shape

3. Delineation

4. Mobility

5. Consistency

6. Tenderness

Shottys Lymph Nodes

Small, mobile, discrete, non-tender lymph nodes.

Tender Nodes

Indicate inflammation or infection in lymphatic system.

Hard Nodes

Suggest malignancy

Supraclavicular Nodes - If enlarged?

Enlargement (LHS) may indicate thoracic or abdominal malignancy.

Tracheal Deviation

Indicates possible mass, atelectasis, pneumothorax, thoracic issues, or mediastinal masses.

Thyroid Inspection

Visual assessment of thyroid gland's size and shape

Gland moves superiorly: Note the movement, contour, and symmetry

Thyroid Palpation - take note of:

1. Size

2. Shape

3. Consistency

4. Nodules

5. Tenderness

Thyroid percussion

Resonant = Normal

Dull = Enlarged (Ant & Inf)

Thyroid auscultate

Listen for Bruit (turbulent blood flow)

Goitre

General term for enlarged thyroid gland.

Non-specific i.e. could be hyper-/hypo-/euthyroidism

Physical characteristics of thyroid gland do not confirm thyroid function --> Rather done via sxs assessment and lab testing

(1) Diffuse enlargement of thyroid gland

Enlarged but no nodules; dt Grave's/Hashimoto's/Iodine deficiency (Endemic goitre)/Idiopathic goitre

(2) Multinodular goitre

Enlarged gland with 2 or more identifiable nodules

Dt metabolic issues rather than neoplastic process

Metastatic suspicion if: Irradiation as child, +ve family history, enlarged cervical nodes, continual enlargement of one nodule

(3) Single nodule

May be: Cyst, benign or malignant tissue (Adenoma/Carcinoma)

Hyperthyroidism vs Hypothyroidism

Hyper:

1. Nervousness

2. Weight loss (Increased appetite)

3. Frequent bowel movements

4. MSK weakness

5. Cardiac palpitations/Tachycardia

6. Increased systole - Decreased diastole

7. Intolerant to heat

8. Warm, smooth, moist skin

9. Proximal muscles weakness + Tremor

10. Graves dx (Exophthalmos + Lid lag)

Hypo:

1. Fatigued, lethargic

2. Weight gain (anorexia)

3. Constipated

4. MSK weakness with muscle cramps

5. Bradycardia

6. Decreased systole - Increased diastole

7.Cold intolerant

8. Dry, course, cool skin, with non-pitting oedema, hair loss

9. Impaired memory, mixed hearing loss, P. neuropathy, carpal tunnel syndrome

10. Periorbital puffiness, swelling hand and feet

Graves Disease

Autoimmune disorder causing hyperthyroidism.

Hashimoto's Thyroiditis

Autoimmune condition leading to hypothyroidism.

Who can you refer to?

Endocrinologist

What special investigations can you do?

1. Blood tests:

a. Thyroid function tests (TSH, T3, T4)

b. Thyroid antibodies

c. Calcitonin levels

2. Thyroid ultrasound

3. Radioactive iodine uptake scan

4. Thyroid FNA & biopsy