Thyroid Examination

Rapport with patient

  • Introductions

Sit on edge of bed

General Inspection (From front and sides)

  • Ask to perform Pizillo’s method
  • Diagnostic facies
  • Lid retraction Horner’s Syndrome Goiter Swellings Scars
  • Distended neck veins Skin changes

Ask to swallow water Inferior border noted

Ask to protrude tongue

Move behind patient & inspect Exopthalmos

G. Palpate from behind

  • Determine overall size Lower border Ask if tender Shape Consistency Nodularity
  • Localization of dominant nodule Test for Mobility Thrill

Ask to repeat swallow

Ask to repeat protrusion of tongue

Palpate cervical lymph nodes

  • Submental
  • Jugular chain
  • Posterior triangle
  • Post-auricular
  • Submandibular
  • Supraclavicular
  • Occipital
  • Pre-auricular

Palpate carotid artery

  • Left
  • Right

Return to front & palpate with thumbs

Auscultate for thyroid bruit

  • Left
  • Right

Assess for tracheal deviation

Assess for Hypocalcaemia

  • Chvostek’s
  • Trousseau’s

Assess for Retrosternal Extension

  • Percussion of manubrium

Assess for SVC obstruction (Note proximal myopathy)

  • Pemberton’s sign
  • Stridor on deep inspiration

Examine for Opthalmopathy

  • Chemosis
  • Conjunctivitis
  • Lid retraction
  • Lid lag
  • Inferior rectus opthalmoplegia

Inspect Hands

  • Acropachy
  • Onycholysis
  • Palmar erythema
  • Sweating
  • Paper test for tremor

Feel radial pulses

  • Rhythm
  • Rate
  • Collapsing pulse

Assess for pretibial myxoedema

Assess reflexes for briskness

Ask for relevant Vitals

  • BP
  • BSL

Ask to examine CVS

Wash hands

## Summary & Interpretation ##