Thyroid examination

Question 1

general structure

Answer 1

inspection x5
palpation x3
(percussion)
(auscultation)
further tests x3

Question 2

inspection

Answer 2

Ask:
weight change
behaviour- anxiety/depression
heat problems

Hands:
Thyroid acropachy (clubbing)
Onycholysis (nail bed rises)
Palmer erythema
Radial pulse- Afib

Face:
expression
symmetry
acromegaly
swelling
scars/rashes
movements

Eyes:
thyroid eye disease
sclera- jaundice/anaemia

Neck:
scars/swelling/lump
movement and tongue protrusion

Question 3

percussion

Answer 3

If there is a palpable thyroid swelling consider percussion for retrosternal thyroid

Question 4

ausculation

Answer 4

• Listen over an enlarged thyroid – use the diaphragm of the stethoscope and ask the
  patient to hold his/her breath – listen over both lobes of the thyroid – In Graves’ disease
  a soft bruit may be heard

Question 5

Further Tests

Answer 5

• Pretibial myxoedema
• Tendon reflexes – hyporeflexia associated with hypothyroidism
• Proximal myopathy – ask patient to stand from seated position with their arms crossed