The Thyroid Examination

General Features

Age, gender, general comfort

Vital Signs

Heart rate, blood pressure, resp rate, temp

Conscious State

Alert, oriented, confused, obtunded

Body Habitus

Weight gain ( ↓ ) / loss ( ↑ ), BMI, shape

Mental State

Anxiety ( ↑ ),mental slowness ( ↓ )

The Nails

Onycholysis ( ↑ / ↓ ), peripheral cyanosis ( ↓ )

Clubbing

Increased soft tissue in distal phalanges (Graves)

Radial Pulse

Tachycardia ( ↑ ) / bradycardia ( ↓ ), rhythm

Pemberton's Sign

For thoracic outlet obstruction - retrosternal goitre

Patient lifts arms as high as possible for 1 min, look for facial congestion and cyanosis

Biceps / Triceps Reflexes

Reduced ( ↓ ) / normal / hyper-reflexive ( ↑ )

The Hair

Alopecia ( ↑ )

The Skin

Pigmentation ( ↑ ), thickening ( ↑ )

The Eyes

Exophthalmos (Graves)

The Eyelids

Lid retraction ( ↑ ), lid lag ( ↑ )

The Orbits

Periorbital oedema ( ↓ ), loss of outer 1/3 of eyebrow ( ↓ )

The Mouth

Swelling of tongue ( ↓ )

Inspection

Scars, veins, erythema, swelling, swallow

Palpation

Size, shape, nodules, thrill, fixation, consistency

Percussion

Upper part of manubrium

Auscultation

Over each lobe for bruits

Auscultate

Systolic flow murmur ( ↑ ), crackles, pericardial / pleural rub

Auscultate Lung Fields

Stridor, crackles, pleural rub

Pretibial Myxoedema (Graves)

Bilateral, firm, elevated dermal nodules

Non-Pitting Oedema ( ↓ )

Patellar / Ankle Reflexes

Reduced ( ↓ ) / normal / hyper-reflexive ( ↑ )