Examination of a Thyroid Swelling – Page 4

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Kocher’s Test : Done in large, bilateral goiter to rule out tracheal narrowing.
1. Extend the neck.
2. Ask the pt to take deep breaths through the mouth.
3. Compress the swelling from both the sides.
Appearance of stridor with slight compression of lateral lobes  Narrowing of trachea  Scabbard trachea of large and longstanding multinodular goiter and Ca thyroid infiltrating trachea.

Berry’s sign: Palpate the Carotid pulsations against the transverse process of the 6th cervical vertebra b/w post border of thyroid and sternomastiod. In Ca thyroid, Carotid pulsations  weak or absent.  Infilration of carotid sheath  Positive. In benign goiter  pulsations are well felt  carotid sheath pushed backwards.

Lid retraction : Due to tonic contraction of the involuntary part of Levator Palpebrae Superioris.

Lid lag : Prevent neck flexion and extension  fix the head with your left hand.

Exophthalmos: Due to retro orbital edema and fat deposition.

Naffziger’s Method: To note the amount and the degree of exophthalmos.
1. Stand behind the pt.
2. See from above.
3. Observe the eyes in supraorbital plane.

Joffroy’s sign:
1. Ask the pt to look upwards with head tilted slightly downwards.
2. Look for wrinkles in the forehead. No wrinkles  sign + ve

Pemberton sign: 1.Elevate both arms above head until they touch the sides of the face.
2. Hold them there for 1 min.
Congestion of face and Resp distress  Thoracic outlet obstruction.

Auscultation: Done especially in the upper pole to hear Systolic bruit.

Gifford’s sign: To diff b/w retro orbital mass (evertion possible) & exophthalmos.

Mobius’ sign: Convergence is Slow, Jerky & Incomplete.

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Submitted by Chetab Raj and Bhargava, JJM Medical college.

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3 Comments

  1. dr.sudhakar said,

    4, January , 2008 at 6:41 am

    very useful,very informative
    thanks

  2. Dr.Capt.S.Srinivasan said,

    26, February , 2013 at 6:24 pm

    very well constructed,including all the relavent points,if you simply fill the sheets you got the diagnosis.

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