Examination of the Thyroid Gland

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:

·  Auscultate the thyroid for bruits, BOTH LOBES! Can be seen in hyperthyroidism.