Thyroid Examination

Question 1

What position do you need the patient in?

Answer 1

Sitting in a chair

Question 2

What equipment do you need?

Answer 2

Stethoscope
Glass of Water
Tendon hamer
Piece of paper

Question 3

What are you looking at during inspection?

Answer 3

Behaviour
Hands - temp, wet/dry, clubbing, colour changes, tremor
Radial pulse - rate and rhythm
Face - dry skin/sweating, eyebrows
Eyes - from front, side and above
Eye movements
Thyroid - shouldn’t be visible - skin changes, scars, masses

Question 4

How do you check for their tremor?

Answer 4

Hands out with piece of paper on top

Question 5

How do you determine whether a thyroid mass is a mass or a cyst?

Answer 5

Ask them to swallow water - mass moves

Ask them to stick their tongue out - cyst moves

Question 6

What and how are you palpating?

Answer 6

Stand behind them, with their neck slightly flexed
Ask if they are in any pain
Thyroid - find upper edge (Adam’s apple), move inferiorly (cricoid cartilage)
- feel each lobe, move laterally
- swallow water
- stick out tongue
- size, symmetry, consistency, masses, palpable thrill
Lymph nodes - submental, cervical, clavicular
Tracheal deviation

Question 7

Where do you percuss?

Answer 7

Downwards from the sternal notch

Question 8

Where do you auscultate?

Answer 8

The lobes - for bruits

Question 9

What special tests do you do?

Answer 9

Reflexes - bicep
Pretibial myxoedema - look at shins
Proximal myopathy - stand up with arms crossed (inability suggests proximal muscle wasting)