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The Thyroid Examination

The thyroid examination can be used to identify signs of hypothyroidism ( ↓ ) and hyperthyroidism ( ↑ ). The exam includes a thorough neck examination which may suggest a goitre or thyroid mass.

The Patient

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 Hands

The Nails

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

Increased soft tissue in distal phalanges (Graves)

The Arms

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 Face

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 ( ↓ )

The Neck

Inspection

Scars, veins, erythema, swelling, swallow
Palpation

Size, shape, nodules, thrill, fixation, consistency
Percussion

Upper part of manubrium
Auscultation

Over each lobe for bruits

The Chest

Auscultate

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

Stridor, crackles, pleural rub

The Legs

Pretibial Myxoedema (Graves)

Bilateral, firm, elevated dermal nodules
Non-Pitting Oedema ( ↓ )
Patellar / Ankle Reflexes

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

Read More...

Cooper DS. Hyperthyroidism. Lancet. 2003; 362: 459-468. Dailey UG. Local Examination of the Thyroid Gland. Journal of the National Medical Association. 1946 Mar; 38(2): 60-61. Gaddipati RV, Meyer DR. Eyelid Retraction, Lid Lag, Lagophthalmos, and Von Graefe's Sign: Quantifying the Eyelid Features of Grave's Ophthalmopathy. Ophthalmology 2008. 115: 1083-1088. Mechanisms in endocrinology: the crosstalk between thyroid gland and adipose tissue: signal integration in health and disease. Santini F, Marzullo P, Rotondi M, Ceccarini G, Pagano L, Ippolito S, Chiovato L, Biondi B.Eur J Endocrinol. 2014 Oct; 171(4):R137-52. Pearce EN. Thyroid hormone and obesity. Curr Opin Endocrinol Diabetes Obes. 2012 Oct; 19(5):408-13. Roberts CG. Hypothyroidism. Lancet. 2004; 363: 792-803.

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