Thyroid examination

Question 1

How should the patient be positioned?

Answer 1

Sitting in a chair

Question 2

What equipment do you need?

Answer 2

Stethoscope, glass of water, tendon hammer, piece of paper

Question 3

What should you inspect?

Answer 3

Behaviour
Hands: Stretch out hands and put piece of paper on the back
Pulse
Face
Eyes: Exophthalmos from front/side/above, conjunctiva, eye movements
Thyroid

Question 4

How should you check for masses in the thyroid?

Answer 4

Ask the patient to swallow water and stick out their tongue

Question 5

What should you palpate?

Answer 5

Flex neck slightly to relax SCM
Thyroid: Palpate from upper edge to cricoid ring, palpate each lobe
Lymph nodes
Trachea

Question 6

How should you percuss the thyroid?

Answer 6

Percuss downwards from the sternal notch?

Question 7

Where should you auscultate?

Answer 7

Auscultate each lobe

Question 8

What other tests should you perform? (Special tests)

Answer 8

Reflexes
Inspect for pretibial myxoedema
Proximal myopathy- ask patient to stand with arms crossed
Pemberton’s sign- ask patient to lift both arms as high as possible and look at face

Question 9

What are the steps in this examination?

Answer 9

1) Inspect: hands, face, eyes, behaviour
2) Check for tremor
3) Check pulse
4) Check eye movements
5) Inspect thyroid, swallow water, stick out tongue
6) Palpate thyroid
7) Palpate lymph nodes
8) Palpate trachea
9) Percuss down from sternal notch
10) Auscultate lobes
11) Test reflexes
12) Inspect for pretibial myxoma
13) Test for proximal myopathy
14) Test Pemberton’s sign