Thyroid Exam

General Inspection
- Well? SOB?
- Facial flushing?
- Alopecia?

Inspection
- Any mass?
- Any scarring?
- Any skin changes?
- Any dilated veins?
• Attempt pemberton sign
- Plethora
- Cyanosis
- Dilated veins
- If have mass, ask patient to swallow water, does it move upwards?

Palpation
- Site - “The mass is felt on the left/right/diffusely over the thyroid gland”
- Size - “With a size of A cm x B cm)
- Border - “I can get below the mass”, “I cannot get below the mass”
- Surface
- Shape
• “The thyroid is uniformly enlarged”, “the mass is felt as a solitary nodule”, “multiple nodules
were felt”
- Consistency
• Soft = normal
• Firm = simple goitre
• Hard = carcinoma or cyst calcification
- Tenderness
• Thyroiditis. Rarely can be bleed into cyst or carcinoma.
- Mobility
• Immobile -> carcinoma
- Thrill
• Thyrotoxicosis
- Tracheal deviation

“A nodular/diffuse enlargement/multiple nodules are felt on the left/right/both sides of the gland.
The size is A cm x B cm. I can/cannot get below the mass. It has a soft/firm/hard consistency. The
mass is mobile/immobile. There is/no palpable thrills. The tracheal is deviation to the left/right/no
deviation.”

Lymph Nodes
- Supraclavicular (medial fossa)
- Cervical (Z shape deep to sternocleidomastoid)
- Submandibular (under mandible)
- Submental (under mental)
- Pre-auricular post-auricular
- Occipital

Percussion
- If cannot get below mass, percuss down the sternum

Auscultation
- Bruits
 • Hyperthyroidism
Thyrotoxicosis Signs
- Tremor testing
• Lay paper
- Onycholysis
- Thyroid acropathy
• Graves
- Palmar erythema and temperature
- Pulse
• Sinus tachycardia
• Atrial fibrillation
- Eyes
• Dipoplia testing
• Lid lag
• Lid retraction (sclera visible above iris)
• Exopthalmos
- Pretibial myxoedema
• Graves disease