Thyroid Examination

Question 1

What do you look for on general inspection?

Answer 1

Is the patient agitated
Body habitus
Appropriately dressed for the day

Question 2

What do you look for in the hands?

Answer 2

Hot and sweaty (hyper), cold and clammy (hypo)
Clubbing (acropachy) clubbing
Tremor - put paper on hand to detect tremor
Pulse - tachy or AF (hyper), Brady (hypo)

Question 3

What signs do you look for in the face?

Answer 3

Normal colour 
Dry skin (hypo), Sweating (hyper)
Hair loss (hypo)

Question 4

What signs do you look for in the eyes?

Answer 4

Exophthalmos - scelra visible below iris
Conjunctival oedema
Exophthalmos - bulging of eyeballs (look from side and top of head)
Eye movements (double H) - look for parlaylysis of muscles
Lid lag - stand at side and get patient to follow finger down

Question 5

What do you look for on general inspection of the neck?

Answer 5

Any obvious lumps or masses - if I was concerned there was a lump I would get patient to swallow some water (thyroid moves up on swallowing)
Any scars from surgery
Thyroglossal cyst - get patient to stick out tongue and it will move upwards

Question 6

What are you feeling for in the neck

Answer 6

Lymph node exam
Feel thyroid superior to inferior and then out laterally to each lobe - if feel any mass or lumps are they smooth, nodular or irregular
Any tenderness or pain
Any thrills - indicate Thyrotoxicosis

Question 7

If you heard a bruit in the thyroid what would you do?

Answer 7

Auscultation the right upper sternal edge (aortic area) to rule out cardiac murmur

Question 8

How do you test for proximal myopathy?

Answer 8

Get patient to cross arms across check

Get patient to stand up from seating position

Question 9

What reflexes would you expect in thyroid disease?

Answer 9

Hyper - brisk

Hypo - slow

Question 10

What kind of oedema would you see in thyroid disease

Answer 10

Pretibial mixoedema - hyper

Non pittting peripheral odema - hypo

Question 11

What would you suggest at the end of a thyroid exam?

Answer 11

Any suspicious features - refer under 2ww
Do TFTs
ECG - if irregular pulse noted
Ultrasound of thyroid