Endocrine
Thyroid Special Tests
- Lid Lag Test
- Stand >1m away from patient and have patient follow your finger without moving their head
- Positive test: lids will move more slowly than the eyes
- Normally, they should be moving simultaneously
- Pemberton’s Sign
- Have patient raise their arms above head for 1 minute
- Look for signs of facial congestion and cyanosis, respiratory distress
- This indicates venous obstruction which can be due to many things, one of which is a large goiter.
- Proximal Muscle Weakness
- Have patient stand up from a chair without using their arms
- Alternative: lift up their arms against resistance
- Proximal muscle weakness can be seen in hypothyroidism
- Have patient stand up from a chair without using their arms
- Deep Tendon Reflexes
- Assess bilateral symmetry and briskness of response
- Patellar reflex
- Brachialis reflex
- Triceps reflex
- Achilles reflex
- Grading: 0 is absent (abnormal), 1+ is slight (normal or abnormal), 2+ is brisk (normal set point), 3+ is very brisk (normal or abnormal), 4+ is clonus (repeating reflex, abnormal)
- Typical Presentations:
- Hyperreflexia (3+ or 4+) characteristic of Hyperthyroidism
- Hyporeflexia (0 or 1+), specifically a delayed relaxation phase, is characteristic of Hypothyroidism most easily seen at ankle reflex
- Assess bilateral symmetry and briskness of response