Examination of Thyroid Gland

Inspection
Sitting Position with Neck
Extending
Exposure Top of Head Mid
Chest
1. Site
In front of Neck
Extending from 1 Steromastoid to
other
Vertically
(Suprasternal Notch Thyroid
Cartilage)
2. Size
3. Shape
4. Movement with Swallowing
5. Surface

Palpation
Semiflexed Position
(Relax Sternomastoid)

Smooth
Adenoma
Puberty
Goitre
Graves

1.
2.
3.
4.
5.
6.
7.

Irregular
Carcinoma

Nodular
MNG

6. Lower Border
(Ask patient to Swallow)
7. Skin
Dilated Veins
Infiltration of Skin
Scar
8. Swelling moves with
Deglutition
Due to Ligament of Berry
If Restriction

Malignancy

Retrosternal Goitre

Large Goitre

Previous Surgery
9. Movement on Protrusion of
Tongue
Thyroglossal Cyst
10. Surrounding Structure
Get Smaller on
Sternomastoid Contraction

11. Other Swelling

Lymph Nodes
12. Ask Patient to Talk
Exclude Hoarseness of Voice

Percussion
Upper Part of Manubrium
(Retrosternal Goitre)

Both hands placed with

Pulp of Fingers over the Gland
Feels systematically both
lobes

Temperature
Tenderness
Site
Size
Shape
Surface
Consistency
Soft

Firm

Hard

Graves

Adenoma

Colloid
Goitre

MNG

Carcinom
a
Calcificati
on of
MNG

8. Thrill
9. Lower Edge
Confirm movement with
swallowing
Feel Lower Edge
10. Surrounding Structure
Skin Sliding, Push & Pinch,
Swelling under skin
Sternomastoid Pinch
Sternomastoid from swelling
during swallowing
Trachea Fixed or not,
Displaced
Carotid Pulse Displaced,
Berrys Sign
Other Swelling Lymph Nodes
11. Movement with
Swallowing
Pizillos Method
(Obese, Short Neck)

Auscultation
Each Lobe (at Upper Pole)
Bruit
Sign of Blood Supply
(Hyperthyroidism)
(Occasionally use of Antithyroid
Drugs)
Differentiate from Carotid Bruit

Pembertons Sign
Lift both arms as high as possible (few moments)
Sign of

Facial Congestion (Plethora)

Cyanosis

Respiratory Distress

Non-Pulsatile Elevation of JVP

Stridor (during Taking Deep Breath through Mouth)

Exam Exopthalmos

Naffzigers
Method
Detect
Exophthalmos

Marked Exophthalmos

Lid Retraction

Stellwags Sign
Unilateral Lid
Retraction

Mocbius Sign
Difficult
Convergence

Joffroys Sign
No Wrinkles

Chemosis

Patient throw Head Backwards

Press occiput against clasped
hand
Laheys Method
Push Gland to 1 side while
examining the other lobe
Criles Method
(for Small Gland)
Thumb placed over Lobe while
patient Swallowing
Other Examination
Chest
Tenderness over the Ribs
Chest
Lung Metastases
Consolidation
Pleural Effusion

Abdomen
Liver
Metastases
CHF
Splenomegaly
Thyroid Lymphoma

Severe Chemosis

Upper Limb
Hand
Warm
Sweaty
Fine Tremors
Water Hammer (Collapsing)
Pulse

Lower Limb
Hyperthyroi
Hypothyroidi
dism
sm
Hyperreflexia
Hyporeflexia
Pretibial
Myxedema

CVS
Tachycardia
Murmurs

Graves Disease
Hashimoto Disease
Back
Vertebral Metastases
Malignant Ascites

Hypothyroidism
Dark Skin
Pale Skin