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