Examination of the Thyroid Gland



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Steve Goodyear MRCS(Ed)

Examination of the Thyroid Gland



Inspection:

  • Patient is to be sat forward in bed, or sat in a chair away from the wall.

  • Neck exposed/shirt off.

  • Inspect from the front of the patient.


The Normal Patient:

  • The thyroid gland should not be visible.

  • The thyroid gland should be impalpable.


Patient with a Goitre:

  • Fullness on either side of the trachea below the cricoid cartilage.

  • OR a distinct, nodular organ either side of the trachea.

  • Any scars on the neck, suggestive of previous thyroid surgery?

  • Does the goitre appear regular or irregular?

  • Ask the patient to swallow, note movement.

  • Ask patient to stick-out tongue-?moves (Thyroglossal Cyst).


Inspection of the Hands:

Note the following:



  • Warmth/sweatiness. (Associated with Hyperthyroidism).

  • Wasting of intrinsic hand muscles. (Associated with Hyperthyroidism).

  • Peripheral tremor-rest a piece of paper on the outstretched hand. (Associated with Hyperthyroidism).

  • Clubbing: seen in Graves Disease (severe hyper)-called “Thyroid Acropachy.”

  • Oncholysis (lifting of the nail off the nail bed)-seen in Graves disease.

  • Tendon xanthomas: can be seen in hypothyroidism.

  • Dry flaky skin: seen in hypothyroidism.

  • Test for carpal tunnel syndrome: can be seen in Hypothyroidism.

Pulse, taken at the radial artery:

  • Tachycardia can be seen in Hyperthyroidism.

  • AF is also seen in Hyperthyroidism.

  • Bounding Pulse: hyperthyroidism.

  • Bradycardia: seen in Hypothyroidism.

Inspection of the Face:

  • Eyelid retraction and lid-lag: test with eye movements: seen in Hyperthyroidism.

  • Opthalmoplegia, conjunctival oedema, chemosis and exopthalmos: seen in Graves' disease.

  • Hair loss & loss of lateral 1/3 eyebrow: seen in Hypothyroidism.



Palpation (is performed from behind):

  • Warn the patient about the procedure!

Palpation of the Thyroid Gland:

  • Palpate the lobes, ?tender.

  • Note symmetry, texture and extent of the goitre. Describe lump, layer of origin and surrounding skin.

  • Ask the patient to sip water and swallow.

Palpation of the Carotids:

  • The carotid arteries may become encased in malignant thyroid disease.

Palpation of the Lymph Nodes:

  • Include the nodes of the posterior triangle, anterior triangle and supraclavicular fossae.


Percussion:

  • Over the manubrium and sternum: retrosternal goitre will cause dullness (malignant thyroid disease).



Auscultation:



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