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Palpation of an organ is its palpation with fingers and palms in order to obtain information about the state of tissues, swelling, increase or decrease in size, pain. The same applies to palpation of the thyroid gland.
The patient should be prepared that during the examination, the doctor will begin to feel his neck – this is a standard medical appointment.
Methods of palpation research
Each doctor has his own developed methods of palpation examination, which are developed over the years of medical practice, which means they will be as informative as possible for the doctor. He can palpate the organ with one hand or both, or even with just a few fingers – it all depends on the condition of the gland, its consistency, soreness, etc. He can stand or sit directly opposite the patient or stand behind him.
Palpation examination is carried out in stages – superficial and deep palpation. During this time, the patient needs to sit or stand. The doctor makes a superficial examination with his right hand – with his fingers a sliding soft movement is made from the cartilage in the middle part to the jugular notch. With the left hand, the doctor holds the patient by the back of the head.
During deep palpation, the doctor works with both thumbs. He places them in front of the surface of both lobes. With other fingers, he wraps his neck in a half ring. To palpate the isthmus, the doctor makes sliding movements with the thumb along the midline.
What is assessed by palpation of the thyroid gland
Dimensions, with an enlarged gland – a characteristic of the state of the tissues of the gland;
Consistency – densely elastic, soft elastic;
Rough or smooth surface;
Identification of nodular neoplasms;
Pain when touched;
Identification of pathological pulsation.
What is a norm?
Normally, the thyroid gland is almost undetectable; on palpation, it can be determined that the consistency is soft-elastic, the surface is smooth, and the structure is homogeneous.
Enlargement of the thyroid gland in size – goiter (hyperplasia)
In Russia, two classifications for assessing the degree of hyperplasia have been adopted.
One of them was developed in 1955 by O. O. Nikolev, who proposed to classify the increase in several degrees:
Zero – the state of the gland is normal, it is not palpable and is not visible during examination;
The first – it is possible to determine the isthmus during swallowing;
The second is that the gland becomes visible due to an increase in size;
The third is the “fat neck” stage. The thyroid gland becomes visible due to the increase in the size of both lobes and the isthmus. Palpation revealed heterogeneity of the structure, diffuse hyperplasia, nodular neoplasms;
Fifth – a significant increase in size, the formation of a goiter.
An increase in I and II degrees without dysfunction can be considered the norm.
The generally accepted world classification of WHO provides for the division of the stages of hyperplasia into only two degrees:
0 – no goiter;
I – visually increase is not determined. Palpation revealed an increase greater than the length of the phalanx;
II – goiter can be detected both during visual examination and during palpation.
What should I look for?
Often, patients are the first to notice signs of change in themselves and then seek medical help.
Signs that should not be ignored:
During swallowing, the gland begins to move along with the larynx or remains completely motionless in some diseases;
Styrous (noisy) breathing caused by pressure on the larynx by an enlarged gland, or enlarged nodes;
Paresis of the vocal cords contributes to the development or intensification of hoarseness;
Pressing the enlarged gland on the esophagus leads to the development of dysphagia – the appearance of belching, hiccups, and other unpleasant sensations.
Palpation signs of goiter in some diseases of the thyroid gland
The consistency of the goiter can be diffuse, nodular or mixed. Against the background of hyperplasia of the thyroid gland, its functional state can be assessed as euthyroidism (normal), hypothyroidism (hormone production is reduced), hyperthyroidism (hormone production is increased).
Diffuse toxic goiter. Hyperplasia of the gland with an increase in hormonal levels, signs of thyrotoxicosis. On palpation, the gland is enlarged to the second or fifth degree, soft or (rarely) densely elastic consistency, sometimes you can hear a systolic murmur during auscultation of the gland.
Endemic goiter occurs due to iodine deficiency. It is diagnosed mainly in people living in areas characterized by a low content of iodine in food and water. It can have any consistency – diffuse, nodular or mixed.
Thyroiditis – inflammation of the gland. Several types of this condition have been identified: autoimmune thyroiditis, subacute de Carvin thyroiditis, etc. Palpation is determined by an increase in the size of the gland, the consistency is lobular-elastic, dense, unrelated to the skin, the surface is bumpy, painful when touched, you can determine the symptom of rocking (pressure one beat causes the other to rock). Riedel’s fibrous thyroiditis is characterized by connective tissue growth in the gland, which is enlarged unevenly, dense consistency to “woodiness”, the surface is bumpy, painful when touched, sometimes soldered to other tissues.
Nodular euthyroid goiter. In the tissues of a healthy gland, a dense knot is palpated.
Diffuse goiter – a uniform increase in the size of the gland, local seals are not detected. Nodular goiter is characterized by a defined tumor-like neoplasm in the form of a dense nodule. The size of the gland itself is not enlarged. The mixed type is characterized by a combination of gland enlargement and the presence of a node.
This disease needs differential diagnosis to exclude thyroid adenoma or cancer. Cancer is characterized by low mobility or complete lack of mobility. The gland is closely connected with other tissues, the cervical lymph nodes are enlarged.