Thyroid examination

Question 1

How should every consultation begin?

Answer 1

Wash hands
Introduction
Patient consent
Explanation

Question 2

How should a patient be positioned for a thyroid examination?

Answer 2

Patient sitting upright

Neck and top half of sternum exposed

Question 3

What should be identified during general inspection?

Answer 3

Restless/ relaxed
Lethargy/ disinterest
Paraphernalia

Question 4

What should be identified when examining the head and face?

Answer 4

Large tongue
Periorbital puffiness (puffiness around the eyes)
Dry, brittle hair
Hair loss from outer 1/3 of eyebrow (hypo)

Question 5

What vital signs should be taken?

Answer 5

Radial pulse (rate/ rhythm to identify tachycardia or bradycardia) 
Offer BP

Question 6

What should be identified when examining the hands?

Answer 6

Sweaty palms (hyper)
Carpel Tunnel syndrome
Tremor (hyper)

Question 7

What should be identified when examining the nails?

Answer 7

Clubbing (Graves disease)

Onycholysis (hyper)

Question 8

What should be identified when examining the eyes?

Answer 8

Exophthalmos
Lid lag
Lid retention
Diplopia

Question 9

What should be identified when inspecting the neck?

Answer 9

Neck swellings (patient should swallow water) 
Scars/ surface changes 
Asymmetry

Question 10

What should be palpated?

Answer 10

Lymph nodes 
Thyroid cartilage (patient should swallow water)

Question 11

What should be percussed?

Answer 11

Percuss down sternum to identify retrosternal goitre

Question 12

What should be auscultated?

Answer 12

Carotid bruits

Stridor

Question 13

What should be examined peripherally?

Answer 13

Ankle reflexes (patient kneeling on chair) 
Pretibial myxoedema

Question 14

What additional examinations should be offered?

Answer 14

Examination for Carpal Tunnel Syndrome

Muscle power