Thyroid Exam

Question 1

Introduction

Answer 1

INTRODUCTION:
• Greet the examiner.
• Greet the patient.
• Introduce yourself and establish rapport.
• Confirm patient’s identity.
• Briefly explain what the examination is about.
• Obtain consent.
• Ask for a chaperone
To the examiner:
I would like to:
• screen my patient for privacy.
• adequately expose my patient (head, neck and upper chest).
• place my patient in an anatomical position (sitting upright).
• sanitize or wash my hands with running water and soap.
• Ask to perform a quick general examination.
• Points to note: Sclera jaundice, conjunctival, etc.

Question 2

Inspection

Answer 2

INSPECTION
Inspect the anterior neck at eye level.
Ask the patient to swallow (you can offer a glass of water). Ask the patient to protrude the tongue.

Question 3

Palpation we palpate what

Answer 3

For 4 Ts

In front of the patient:
• Check for differential warmth
• Tenderness
• Extent of the mass
• Skin attachment
• Size (horizontally and vertically)

• Tracheal deviation
• Behind the patient:
• Palpate the lobes for mass (left and right)
• Consistency
• Mobility of the mass
• Carotid pulsation on both sides (one at a time)
• Regional lymph nodes (submental, submandibular, pre-auricular,
post-auricular, cervical, supraclavicular)
• Palpate the scalp for metastatic mass (scalp swellings)

Question 4

Percussion what should we percuss in thyroid exams

Answer 4

Retrosternal extension (over the manubriosternum, i.e. angle of Louis)

Question 5

Auscultation of the thyroid

Answer 5

Thyroid bruit (over the superior thyroid poles)

Question 6

Eyes signs

Answer 6

Nafzigers sign – checking for exophthalmos from behind
Dalrymple sign – widening of palpebral fissure (exposure of both whites of sclera above and below the iris). Check this by asking the patient to stare at a distant object at eye level.
Stellwag’s sign – infrequent blinking
Mobius sign – loss of convergence
Von Graefe’s sign (lid lag) – lid lag on downward gaze.
Joeffery sign – absence of wrinkling on forehead when patient looks up with the head stabilized.
Ophthalmoplegia

Question 7

Hands : what should I do

Answer 7

Palm (warm and moist), Fine tremors, Pulse (fast and bound- ing), Blood pressure (elevated), Proximal myopathy of upper limbs

Question 8

Legs : what should we do

Answer 8

*Pretibial myxoedema, Ankle reflex, Proximal myopathy of lower limbs, Sweaty soles.

Thank the patient and the examiner