Thyroid Examination

Inspection: General Inspection: comment on:

- Build and state of nutrition:
 Thin and underweight hyperthyroidism
 Obese and overweight hypothyroidism
 Cachexia and anemia signs thyroid carcinoma
- Facial expression:
 Excitement/staring or protruding eyes Hyperthyroidism
 Puffy face without any expression (mask face) Hypothyroidism
- Mental state and intelligence
- Does the patient look ill (thyrotoxicosis), hypo-/hyper-thyroid?
- Patient looks sweating or cold appropriately dressed for weather
(wearing heavy clothes in hot weather or light cloths in cold weather)
- Pretibial myxoedema/Generalized Edema (non-pitting)
- Listen for: (signs of tracheal compression or laryngeal nerve damage)
o Strider
o Dyspnoea worsen when neck is flexed forward or laterally
o Hoarse voice, slow speech(in hypothyroidism)
o Anxious/irritable or depressed (hyperthyroidism)
Hyperthyroidism Hypothyroidism
Hands Pulse: Tachycardia Pulse: Bradycardia
Skin: Hot Skin: Cold
Palm: Sweaty skin Palm: Dry skin
Nails: Clubbing (in Graves) Discoloration of the fingers
Hand: Fine Tremor (when hands
extended watch for tremor or put
a paper on the patient hands and
see if it is shaking)
Face Eyes: Exophthalmoses Eyes: Pale
(Look for signs Eye movement: Skin: Puffy face ‘Toad-like’
of anemia, Ophthalmoplegiaparalysi or mask like face
central s of one or more of optic
cyanosis, muscles Graves
dyspnoea) Lid lag
Lid retraction
Skin: Sweating
Neck Thyroid Swelling:
(normal thyroid Is there thyroid swelling? if present look for fullness on either
is not obvious side of the Trachea below level of cricoid cartilage.
on inspection) Is the swelling bilateral or unilateral?
Does it move on deglutition?
- Lymph nodes hardly move on swallowing.
- Thyroid will normally move upwards with
contraction of pharyngeal muscles.
- Invasive thyroid carcinoma may result in fixation of

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 gland to surrounding structures.
- Very large goitres may be immobilised because they
occupy all available space.
Does it move on protrusion of the tongue?  sign of
thyroglossal cyst (moves when tongue is out) , thyroid doesn’t
Lymph nodes: Is there any obvious lymphadenopathy?

Pizzillo’s method: to inspect the thyroid easier, extend the neck

Hands are placed behind the head and the patient is asked to
push the head backward against the clasped hands on the
occiput. (to see small nodules)

Palpation - Palpate the lobes by “Lahey’s method”:

With patient sitting o To palpate thyroid lobes, push one lobe to the opposite site
palpate thyroid gland and examine it with the other hand
from behind with the - “Crile’s method”: place thumb on thyroid while patient is swallowing
head slightly flexed Comment on:
- Bilateral/unilateral
- Surface:
o Smoothgrave’s
o Bosselatedmultinodular
- Consistency:
o Firm Hashimoto, thyrotoxicosis
o Uniform
o Hard carcinoma, Riedel’s Thyroditis
- Mobility:
o Mobile(horizontally or vertically) or fixed (in carcinoma)
- Extend:
- To know the extension of the thyroid: ask the patient to swallow so
the thyroid will move up and lower border is palpated for any
extension downwards
Position of the trachea:
- Goiter can push the trachea laterally
- “Kocher’s test”: gentle compression on the lateral lobe of the thyroid
produces strider sign of tracheal obstruction/compression
o Positive in multinodular goiters and carcinoma with tracheal
infiltration
Feel the carotid Pulse: (Berry’s sign)
- Absent in malignant carcinoma where the carotid sheath is
completely engulfed
- “Pemberton’s sign”: for engorgement of neck veins
o Ask the patient to raise the hands above the head and the
arms touch the ears
Palpate the cervical lymph nodes:
Palpable or not?
- Palpable lymph nodes can indicates metastasis  papillary
carcinoma causes secondary lymph nodes

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 - Hashimoto’s  increase risk to lymphoma
Percussion - Percuss upwards over the manubrium sternum to the sternal angle to
(done to know the extension assess for retrosternal extension
of the enlargement , CT is - You can also percuss on the sides of the manubirum
more accurate) - However, better assessed by palpating for the lower border of the gland
when the patient swallows with the neck extended
Auscultation listen over both lobes for thyroid systolic bruit
- When vascularity increases, bruits are heard 
HyperthyroidismGrave’s