The following document was written by Mr Vik Veer MBBS(lond) MRCS(eng) DoHNS(eng) in Dec 2007. You may use the information here for personal use but if you intend to publish or present it, you must clearly credit the author and
This site is not intended to be used by people who are not medically trained. Anyone using this site does so at their own risk and he/she assumes any and all liability. ALWAYS ASK YOUR SENIOR IF YOU ARE UNSURE ABOUT A PROCEDURE. NEVER CONDUCT A PROCEDURE YOU ARE UNSURE ABOUT.

Examination of the Thyroid

Ask for consent and then continue with inspection

“Is there any pain at all? (response) and would it be alright if, while i am examining you, that i speak to the examiner about you?"

(remember to wait for response - too often we rehearse these examinations so often that we forget to wait for the answers to these questions in the panic of an exam)

Expose the neck to below the clavicles

“Firstly on general inspection – there is no obvious restlessness, anxiety, sweating, vitiligo and the patient is dressed appropriately for the temperature of the room.” “Moving on to the hands"
"There are no signs of thyroid acropachy (thyroid clubbing), onycholysis, or tremor"
turn hands over
"No increased sweating or palmar erythema in the palms. The pulse appears to be regular (AF) with a heart rate which is within normal limits”


Neck Examination

“On inspection there are no obvious lumps, scars, or raised jugular venous pulse (neck vein obstruction).”
“Stick out your tongue (assess for any lump movement in midline).”
“Now would you please take a sip of water in your mouth but don’t swallow it until I say ‘go’.” (once the patient has taken a sip ask them to extend his/her neck a bit until you can clearly see the neck and then ask them to swallow. Without this break the swallow action occurs with the glass of water obscuring your view.)

Ask the patient to count to 10 – to assess for hoarseness.

Again ask if there would be any pain if you were to touch the patient. Stand behind the patient and examine with the pulps of your fingers.

Percuss over the sternum for retro-sternal extension.

You can now attempt to wrap up the examination with some final examination that they may or may not ask you to do.

"I would then check for slowly relaxing reflexes (ankle), pre-tibial myxoedema, and proximal myopathy (upper arm).
"I would also take a thyroid status history"

"I would then examine this patient’s vocal cords with a flexible fibreoptic nasoendoscope to assess for any palsy."


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