Thyroid Examination

Question 1

What are you observing for on general inspection?

Answer 1

Build
Inappropriate clothing
Skin
Hair
Restlessness

Question 2

Summarise what looking for in hands?

Answer 2

Temperature
Sweaty?
Palmar erythema
Clubbing tremor

Question 3

What else in hands?

Answer 3

Take pulse and inspect forearm for muscle wasting

Take BP

Question 4

What would you do when inspecting the face?

Answer 4

Look for: exopthalmos, periorbital swelling, conjunctival suffusion.

Examine for lid lag - hold finger high and ask patient to follow it with eyes, then rapidly move finger downwards. If present upper eyelid will lag behind the eyes downward movement.

Examine eye movement - H shape. Eye movement can be restricted in Grave’s disease due to abnormal connective tissue deposition in the orbit and extra-ocular muscles.

Question 5

What looking for in neck inspection?

Answer 5

• Any skin changes/ erythema? Any scars?
• Look for goitre
• Ask patient to swallow, inspect neck for mass that moves.
• Inspect back of tongue for lingual thyroid.

Question 6

What are you doing when palpating neck from the front?

Answer 6

Checking if trachea is central

Question 7

What are you doing when palpating the neck from behind?

Answer 7

1. Place 3 middle fingers of each hand along the midline of the neck below the chin.
2. Slowly move fingers downwards until you reach the area of the thyroid gland. (Located just below thyroid cartilage (adams apple)).

Observe:-
- Is there an enlarged gland? How big is it?
- Is it hard, soft, smooth or nodular?
- Is it symmetrical?
Ask them to swallow whilst palpating; does it move or is it tethered?
- Can you feel above or below it? A large goitre may extend below the sternum.

Question 8

Percussion?

Answer 8

Percuss sternum for retro-sternal goitre. May indicate a large thyroid mass extending posterior to the manubrium.

Question 9

Auscultation?

Answer 9

Use bell of stethoscope for thyroid bruits caused by increased blood supply to overactive thyroid.

Question 10

End pieces?

Answer 10

Check ankle reflexes and inspect for pre-tibial myxoedema. Hypothyroidism results in normally brisk ankle reflexes which are slow to return to resting state (slow-relaxing reflexes).

• Say you would: take blood samples to assess thyroid function (TFTs) and perform fine needle aspiration of any masses found on examination to determine histology.