- normal size for a thyroid depends on this dietary component

Iodide

- an increased thyroid gland size is characterized by this level of iodide ingestion

Low

- this thyroid gland lobe tends to enlarge more than its counterpart when disorders are associated with diffuse increases in size

Right

- the laryngeal prominence (Adam's apple) consistently lies this distance above the isthmus of the thyroid

4 cm

- at this distance above the suprasternal notch the Adam's apple can be confused with a goiter (lying to high in the neck)

10-12 cm

- when a thyroid is not palpable on examination, it indicates that the laryngeal prominence is approximately this distance from the suprasternal notch

5 cm or less

- the thyroid gland is affixed to the larynx and trachea by this loose CT

Pre-tracheal fascia

- from top to bottom, the structures that ascend in the neck during swallowing are

Thyroid cartilage

Cricoid cartilage

Thyroid isthmus

- during exam, the patient should be provided with this to facilitate an easy exam

glass of water to help with swallowing

this gland should be palpated from shape, size, symmetry, mobility, and consistency

Thyroid

- normal consistency for the thyroid

Rubbery

- palpably enlarged thyroid gland

- lateral lobe in the frontal projection larger than the terminal phalanx of the thumb

- visibility of the gland in the neck

- multinodular, diffuse, or solitary

Goiter

- at least two detectable nodules are palpable within the thyroid tissue

- firm and sometimes may calcify

Multinodular goiters

- both thyroid lobes enlarge

- remain smooth and non-nodular

- can increase in size by up to 5-10 times normal

- pt's complain of difficultry swallowing

- activity unrelated to its presence

Diffuse goiters

- when a large goiter extends from the neck into the superior mediastinum through the thoracic inlet

Substernal thyroid

- when a pt elevates their arms above their head and the thoracic outlet is obstructed

- venous congestion and cyanosis indicate this

Pemberton's sign

- physical characteristics of a nodule indicate what regarding its benign or malignant nature

Nothing

- percent of solitary nodules that are malignant

10%

- nodule that concentrates iodine on a thyroid scan

- almost always benign

Hot nodules

- nodule that fails to concentrate radioactive iodine on a thyroid scan

- 10-20% chance of being malignant

Cold nodule

- Rapid growth, hard texture, irregulars borders, fixation to surrounding structures, Delphian/cervical lymph node enlargement, history of radiation exposure, cystic on US

Characteristics that suggest malignancy

- located just above the thyroid isthmus

- slightly left of the midline

- palpable as a result of metastasis from thyroid or laryngeal cancer

Delphian lymph node

- can be confused with a Delphian lymph node

- cystic sweeling presents at any age as a tense, nontender, mobile, round mass at the level of the hyoid

- moves upward in neck when pt protrudes tongue (when attached to base of tongue)

thyroglossal duct cyst

- groups of disorders characterized by sustained elevation of plasma levels of free thyroid hormones

Causes

hyperthyroidism, ingestion of thyroid hormone, thyroid hormone producing tumors of non thyroidal origin, iodide-induced, hashi-, toxic nodular goiter, excessive TSH

Thyrotoxicosis

- heat intolerance, nervousness, anxiety, excessive sweating, palpitations, diarrhea, amenorrhea, weight loss, goiter and low grade fever

Symptoms of thyrotoxicosis

- lid retraction, lid lag, fine finger tremor, moist warm skin, resting tachygardia, thinning and loss of hair, onycholysis of nails, muscle weakness, brisk deep tendon reflexes

Physical exam signs of thyrotoxicosis

- thyrotoxicosis + exophthalmos, vitiligo (no pigment), fingernail clubbing, pretibial myxedema

Graves' disease

- abnormally low levels of free thyroid hormone

Causes

autoimmune thyroiditis (Hashimoto's), thyroid destruction following irradiation of Graves disease, pituitary deficiency

- cold intolerance, lethargy, mental dullness, constipation, menorrhagia, loss of libido, weight gain, hoarseness, loss of sweating

Symptoms of hypothyroidism

- coarse, cool and dry skin; slow, deep and nasal speech; bradycardia, periorbital puffiness and goiter

- coarser hair, brittle nails, delay relaxation of Achilles reflex, carpal tunnel syndrome, macroglossia

Physical exam signs of hypothyroidism