Thyroid exam

• Preparation
  • Wash hands
  • Get water for patient
  • Exposure: chin to manubrium and clavicles
• Inspection (extend neck slightly, use tangential light, can inspect with swallowing water)
  • Scars (thyroidectomy scar)
  • Masses, lesions
  • Swelling, discolouration, muscle atrophy/hypertrophy
  • Goitre (diffusely enlarged thyroid)
  • Swallow water - comment on size, contour, symmetry, movement of thyroid gland
• Palpation (anterior approach)
  • Landmark
    • Thyroid cartilage (Adam’s apple)
    • Cricoid cartilage (below thyroid cartilage)
  • Thyroid isthmus
    • Below cricoid cartilage, overlying 2nd, 3rd and 4th tracheal rings
    • Feel between cricoid cartilage & suprasternal notch
    • Swallow - palpate for enlargement, masses as it moves up
  • Thyroid lobes
    • Fingers move laterally into gutter between trachea and SCM
    • Ensure SCM relaxed (head slightly tilted toward side to be examined)
    • One hand stabilize the trachea
    • Other hand - palpate thyroid lobe
    • Comment on enlargement, masses
  • Findings to describe:
    • Palpable vs non-palpable
    • Size of gland
    • Texture
    • Tenderness
    • masses/nodules - single/multiple
    • Regional lymph nodes
• Auscultation
  • Listen for thyroid bruit
  • Use bell
  • Listen for low-pitched sound
• Post-encounter questions:
  • List 5 sign/symptoms of hyperthyroidism
  • List 5 sign/symptoms of hypothyroidism

Rational Clinical exam

• Does this patient have a goiter (1995)