Clinical examination of the thyroid. Hugo R K Lisbôa, MD, Ph.D. Medical College University of Passo Fundo - RS BRAZIL. Objectives of this lecture.
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Hugo R K Lisbôa, MD, Ph.D.
University of Passo Fundo - RS
The clinical examination of the thyroid is a
powerful tool for the diagnosis of the most
comum thyroid disease
The thyroid lies immediately under the skin it is easily reached by inspection and palpation.
Oil on canvas. 1967 Tomie Othake, Brazilian Painter
Four anatomic points must be identified
before palpation of thyroid gland is
Does clinical examination gives
an accurate estimation of the thyroid
Skvor J, showed a discrepancy between palpation and ultrsonogrphy among 88 individual of 13 years old
Palpation overestimated in 24 occasions
underestimated in 7 occasions
Ultrasonography was suggested as an essential method for the evaluation of the thyroid in children
Two experts and two young physicians
examined twice 53 adults and they agreed
in 30% of the the cases
Intra observer variation kappa= -0,04 and 0,54
Inter observer variation kappa= 0,44 e 1,0(1)
Two experts examined 152 thyroid lobes measuring
solid nodules and they agreed in 45 %
Inter observer variation - kappa = 0,55 e 0,6 (2)
Ueda D, examined 300 healthy children and found a positive correlation among thyroid volume and weight and height. (1).
Takalo RM et al, found a positive correlation in young
individual of 13 years among thyroid volume measured by
ultrasound and the weight and body surface area(2)
Relationship to other physical variation
characteristics in children
The thyroid volume was found to have a positive correlation with body surface area, age and skinfold but in a multiple regression analysis only body surface area remained associated with thyroid volume.
The upper limit (95th percentile) of the ratio of thyroid volume to body surface area (ECOBODY Index) was 6.2 ml/m2.
Accuracy of clinical examination in the variation
diagnosis of goiter
Considering this index as the criterion standard, the estimated performance of clinical examination for the detection of goiter in the 1094 schoolchildren was:
sensitivity of 41%,
specificity of 91%,
positive predictive value of 27%
negative predictive value of 95%.
Accuracy of clinical examination in the variationdiagnosis of goiter
Delange et al, studied 7599 European schoolchildren
recommended that thyroid volume measured by
ultrasound should be considered dependent of age, sex
and body surface area in non iodine deficient areas
in that continent
Riehl J et al, found, among adults in a deficient iodine
intake area, that the thyroid volume was dependent
of the age.
Individuals with less than 21 years 13,3ml
Individuals with more than 70 years 29,9 ml
A good correlation was found between clinical examination and ultrasonography (r2=0,872) in large
goiters (35,9+-24ml) .
Thyroid gland is considered to be hard if it had
a consistency similar to the thyroid cartilage.
In the diagnosis of goiter in areas of mild to severe iodine deficiency where the thyroid glands are bigger
In the identification of normal thyroid due to its good predictive negative value