The Thyroid Gland is a butterfly-shaped gland found in the lower front part of the neck. Its lobes (the butterfly wings) wrap around the trachea and are connected at the centre by an Isthmus. The thyroid gland’s primary function is to secrete hormones that regulate our metabolic rate, protein synthesis and growth. These notes will outline the Thyroid Gland Nursing Assessment, but before reading this, make sure that you’ve understood the following:
Thyroid Gland Nursing Assessment Part 1: History
Issues with the thyroid gland tend to progress slowly, and obtaining a thorough history will identify the need for further investigations. Start by introducing yourself to the patient, and find a private area to initiate the assessment. Once the patient is comfortable, you can start by asking about their Risk Factors, including family history or personal history of thyroid disease, goitre or autoimmune disease. You should also ask about recent exposure to Iodine, as it contributes to hyperthyroidism.
Several thyroid tests contain Iodine, so it’s essential to ask the patient if they’re allergic to Iodine or shellfish, a food rich in Iodine. Next, you can ask questions to evaluate your patient’s symptoms and ask whether they’ve recently been experiencing:
Fatigue
Fluctuation in weight
Intolerance to heat or cold temperatures
Depression, irritability or anxiety
Menstrual irregularities
Muscle weakness, cramps or pain
Palpitations or exertional dyspnoea
Constipation or increased defecation
Hoarseness
Anterior neck pain
Hypersomnolence or insomnia
Lastly, evaluate the patient’s knowledge about the condition, their psychological state, and support system. Once you’ve obtained a thorough medical history, you can move on to the physical assessment to better understand the patient’s physiological status.
Thyroid Gland Nursing Assessment Part 2: Physical Examination
Physically Assessing the thyroid gland is relatively easy, and it’s often done as a routine whenever a patient is getting a general physical assessment. Start by introducing yourself and your role, and give a brief explanation of where the thyroid gland is and its main role. Once the patient feels comfortable, you can initiate the assessment by identifying the landmarks. Inspect the lower part of the neck between the sternocleidomastoid muscles for swelling and asymmetry. Ask your patient to extend their neck upwards and swallow, and while doing that, you should see the thyroid tissue rising.
Following that, palpate the thyroid to outline its size, shape, consistency and symmetry and ask your patient if they feel any tenderness while you’re doing the assessment. Tenderness of the thyroid gland may indicate Thyroiditis; a soft texture of the gland can show Graves Disease, while firmness is often an indicator of Hashimoto Thyroiditis or Malignancy.
If you’re examining your patient from the posterior position, your hands should encircle the patient’s neck. Rest your thumb on the nape of the neck while your index and middle fingers palpate the thyroid isthmus and anterior surfaces of the lateral lobes. The isthmus should feel firm and can usually be described as having a rubber band consistency.
Next, you should examine the lobes more thoroughly by asking your patient to flex their neck forward and then tilt slightly to either side. Typically, the isthmus is the only part of the thyroid gland that can be palpated; however, in very skinny patients, you might also be able to palpate the lobes.
If you notice that the thyroid gland is enlarged, you will need to auscultate both lobes using a stethoscope. This will allow you to listen to the blood flow through the gland. If your patient has an increased blood flow through their thyroid gland, you’d hear a localised audible vibration of a bruit, indicative of hyperthyroidism.
Thyroid Gland Nursing Assessment Part 3: Medical Tests
By completing the health history and physical assessment, you will be able to determine whether the patient requires further investigations of their thyroid gland. If you suspect that your patient might have hypo/hyperthyroidism, you should refer them to a primary medical provider specialising in endocrine glands. However, in the meantime, the patient would benefit from the following blood tests:
1. Serum Thyroid-Stimulating Hormone:
This is typically the first screening test performed to examine thyroid function. This blood test can identify minimal, seemingly insignificant changes in serum TSH that show the difference between Euthyroid (normal thyroid function) and hyper/hypothyroidism. This test will also help determine the cause of the thyroid imbalance, whether there is an issue with the thyroid gland, pituitary or hypothalamus. Lastly, the Serum TSH blood test monitors the patient’s progress when taking thyroid hormone replacement medications.
2. Serum Free T4: measures the free unbound thyroxine (T4) which is the only part of T4 that is metabolically active.
3. Serum T3 and T4: measures the protein-bound and free hormone levels that occur in response to TSH secretion
4. T3 Resin Uptake: measures the amount of thyroid hormone bound to Thyroxine-Binding Globulin (TBG) and the number of available binding sites. If the thyroid is functioning at normal levels, around one-third of all TBGs should be full, leaving the rest open to bind with the added T3 from the test.
5. Thyroid Antibodies: identifies thyroid antibodies that cause autoimmune thyroid disease.
6. Radioactive Iodine Uptake: measures the rate of iodine uptake by the thyroid gland. Patients with hyperthyroidism will have a high uptake of Iodine, whereas those with hypothyroidism will have a poor uptake.
7. Serum Thyroid Globulin: Detects the presence or recurrence of thyroid carcinoma
Apart from blood tests, the primary medical provider might request the following medical tests:
8. Fine-Needle Aspiration Biopsy: If a mass is detected on the thyroid, a small gauge needle is used to biopsy the thyroid tissue. This will classify the mass as benign, malignant, suspicious or insufficient.
9. Thyroid Scan: During a thyroid scan, the provider would use a scintillation detector or gamma camera to scan over the thyroid area and create an image of the distribution of radioactivity. The scan would determine the location, size, shape, anatomic function of the thyroid gland