HOW TO EXAMINE THYROID:

Thyroid

examination frequently appears in Exams. Youll be expected to pick up the

relevant clinical signs using your examination skills.

.Wash your hands..Introduce yourself

Confirm patient details

Explain the examination to your patient..gain consent

*Start your examination with General inspection of the patient.

INSPECTION:
Does the patient appear hyperactive? agitation / anxiety / fidgety (hyperthyroidism)

Hand examination of your patient:

Inspect the patients hands for:
(hypothyroid)

Dry skin

Increased sweating (hyperthyroid)

Palmar erythema reddening of the palms at the thenar / hypothenar

eminences hyperthyroidism

Look for Peripheral tremor

1. Ask the patient to place their arms straight out in front of them

2. Place a piece of paper across the backs of their hands

3. Observe for a tremor (the paper will quiver)

**Peripheral tremor can be a sign of hyperthyroidism

Face Examination of your patient:

Look for:

Dry skin hypothyroidism

Sweating hyperthyroidism

Eyebrows loss of the outer third hypothyroidism (rare)

Examine Eyes of your patient:

Look for:
Exophthalmos (anterior displacement of the eye out of the orbit)
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Inspect from the front, side and above

Note if the sclera is visible above the iris (lid retraction) seen in Graves disease

Inspect for any redness / inflammation of the conjunctiva

Eye movements (H -Shape test)

1. Ask the patient to keep their head still & follow your finger with their eyes

2. Move your finger through the various axis of eye movement (H shape)

3. Observe for restriction of eye movements (and for double vision)

Now check for Lid lag

1. Hold your finger high & ask the patient to follow it with their eyes (head still)

2. Move your finger downwards

3. Observe the upper eyelid as the patient follows your finger downwards

Examination of Thyroid
Inspect the midline of the neck (in the region of the thyroid)

Any skin changes / erythema?

Any scars? previous thyroidectomy scars can easily be missed

Note any swelling / masses in the area

assess size & shape.

Ask patient to swallow some water:

Observe the movement of the mass

Masses embedded in the thyroid gland will move with swallowing

Thyroglossal cysts will also move with swallowing

Lymph nodes will move very little

Ask patient to protrude his tongue:

Thyroid gland masses / lymph nodes will not move

PALPATION :

Check Radial pulse for:

Rate:

Tachycardia (hyperthyroidism)

Bradycardia (hypothyroidism)

Rhythm irregular (AF) thyrotoxicosis

**Before starting palpation.of thyroid gland,.Ask if the patient has any pain in the neck
before palpating.

Stand behind the patient & ask them to slightly flex their neck

Place your hands either side of the neck.(palpate from behind)

The approach is from behind so always tell the patient what you will be doing and that
you will be behind him.

When palpating the thyroid gland, assess the following:

Size of thyroid gland

Symmetry

Consistency

Masses
Palpable thrill

**You should also examine while the patient drinks to assess whether the lump

moves with swallowing..

Examine the cervical nodes:
After examining Thyroid gland... still behind the patient, examine the cervical lymph
nodes. You should also examine the eyes from behind and above to look for any
exophthalmos

PERCUSSION:
.Now Percuss downwards from the sternal notch.
Retrosternal dullness may indicate a large thyroid mass, extending posterior to the
manubrium..

AUSCULTATION:
Auscultate the thyroid gland for any bruit.

Bruit is a sign of increased blood flow,may be heard in hyperthyroidism.

Special tests for Thyroid Examination:

Check for Proximal myopathy:

Ask patient to stand from a sitting position with arms crossed

An inability to do this suggests proximal muscle wasting

(Proximal myopathy is associated with hyperthyroidism)

Look for Pretibial myxedema:

It most often presents as asymptomatic, bilateral diffuse nonpitting edema in the pretibial area.
Pretibial myxedema is nearly always associated with Graves disease.

Check for Reflexes

Biceps : hyporeflexia is associated with hypothyroidism

Achilles reflex test :

Measuring the speed and relaxation of the Achilles tendon reflex twitch is a traditional
method for judging thyroid function, because in hypothyroidism the relaxation is visbly
delayed.

*SAY THANKS to your patient, and Wash your hands .