Thyroid Examination

Question 1

How would you begin the examination?

Answer 1

1. Wash hands
2. Introduce yourself
3. Identify the patient
4. Gain consent (may need to expose neck, forearms and lower legs)
5. Seat patient comfortably in chair so you can see all sides

Question 2

What do you look for on general inspection?

Answer 2

Build, inappropriate clothing, restlessness, confusion, quality of skin and hair, sweating, tremor, goitre

Question 3

What do you look for on inspection of the hands?

Answer 3

Temperature/sweating
Clubbing
Palmar erythema
Brittle nails
Onycholysis
TREMOR - piece of paper
Pulse - tachycardia, bradycardia or AF

Question 4

What do you inspect the forearm for?

Answer 4

Muscle wasting

Question 5

What do you inspect the eyes for? And how should you show you are doing this?

Answer 5

Exophthalmos: proptosis
Chemosis
Periorbital/lid oedema
Lid retraction

Inspect from each side and over the top of the head

Question 6

What tests do you do with the eyes?

Answer 6

H shape to check for myopathy of extraocular muscles (pain or diplopia?)
Lid lag - look up then down quickly
Visual acuity - cover one eye and hold fingers up
Say you would do fundoscopy

Question 7

What do you do on inspection of the neck?

Answer 7

Look for masses
Ask patient to take water in mouth and swallow
Ask patient to protrude their tongue - look for mass moving and look at the back of the tongue as they do this too

Question 8

What is the name of the mass if it is on the back of the toongue

Answer 8

Lingual thyroid

Question 9

What is the name of the mass if it moves on protrusion of the tongue

Answer 9

Thyroglossal cyst

Question 10

What do you do on palpation of the neck?

Answer 10

Tracheal deviation - feel cricoid bone too to check it is in midline
From behind:
Lymph nodes
Thyroid gland - describe any masses and feel whilst patient swallows and protrudes tongue

Question 11

What do you do on percussion and what does this test for?

Answer 11

Percuss down from thyroid to the upper sternum and listen for persistant dullness as you move down. This may show retrosternal extension of goitre

Question 12

What do you do on auscultation?

Answer 12

Ask patient to hold their breath and auscultate the thyroid gland lobes (not carotid!) with bell of stethoscope for bruits

Question 13

What do you do on the legs and also standing?

Answer 13

Inspect lower legs for pretibial myxoedema
Check ankle reflexes (delayed relaxation = hypothyroidism)
Fold arms across chest and ask them to stand from sitting - checks for proximal muscle weakness

Question 14

What would you do to finish the exam?

Answer 14

Thank the patient

Wash hands

Question 15

What would you say to conclude?

Answer 15

1. Visual acuity (if not already done)

2. Fundoscopy