Thyroid

Question 1

What is the process for a thyroid examination?

Answer 1

Introduction, name and DOB.
Explain purpose, gain consent and ask about any pain or tenderness in their neck.
Expose patient adequately.

1. General observation: comfortable, body habits, clothing (suitable for temperature or not)
2. Hands: clammy, hot, clubbing, tremor
3. Wrist: pulse
4. Face general: loss of hair, dry skin
5. Eyes:
   - sclera visible above the iris
   - view from the side for exophthalmos
   - to confirm exophthalmos: tilt head back and look from above at supraorbital ridge for protrusion
   - H test and ask them about any double vision (Graves disease of the extraocular muscles)
   - follow finger up and down, check for ptosis
6. Neck:
   - observe; lumps, bumps, scars
   - do swallow test to see if lump umoves with thyroid
   - stick tongue out; to see if lump moves upward
   - reticuloendothelial examination
7. Thyroid gland:
   - use three fingers on each side
   - find the hyoid bone above Adam’s apple (thyroid cartilage) (The tips of the lobes touch the bottom of the thyroid cartilage)
   - shouldn’t be palpable unless patient is thin or gland is enlarged
   - feel downwards over the thyroid, to the isthmus
   - feel the lobes
8. Thyroid lump:
   - check mobility/tethering to skin, and if you can get under it
   - check for any pain or tenderness
   - percuss chest if suspected retrosternal mass
9. Ankle: check ankle reflex
10. Legs: check for pretibial myxoedema
11. Thank patient, tell them it’s finished and invite them to put their clothes back on
12. Comments to examiner:
    “If I had any concerns about suspicious features I would want to be referring under the 2 week wait system.”
    “I would like to do some directed thyroid tests and a USS of the thyroid to look at the lumps and bumps”