Examination of the Thyroid Gland

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Last updated: January 3, 2018

Revisions: 7

The thyroid is an endocrine gland located in the neck. It secretes hormones that are
responsible for metabolic rate, protein synthesis, and the body’s sensitivities to other
hormones.

In this article, we shall look at how to perform an examination of the thyroid gland, and
detect signs of thyroid disease.

Introduction
Introduce yourself to the patient
Wash your hands
Briefly explain to the patient what the examination involves
Ask the patient to sit down on a chair
Make sure there is sufficient space so you can access the chair from both
front and behind

General Examination
Comment on the patient’s body habitus
Assess for signs of:
Obvious alopecia or vitiligo
Signs of abnormal temperature regulation (sweating or shivering)
Obvious fine tremor

The Hands
Inspect the nail beds and fingertips for thyroid acropachy or onycholysis
Inspect the palms for palmar erythema

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 Assess for fine tremor
Ask the patient to hold hands outstretched with palms facing downwards
and place a piece of paper on top of the hands; look for fine movement of
the paper

Feel both hands and assess their temperature

Palpate the radial pulse
For both rate and rhythm changes

Adapted from work by CopperKettle, Herbert L. Fred, MD and Hendrik A. van Dijk [CC BY 2.0], via
Wikimedia Commons

Fig 1 – Features of thyroid disease in the hands. A) Thyroid acropachy – clubbing and swelling of the
digits and toes. B) Onychyolysis – separation of the nail from the nail bed.

The Eyes
Step behind the patient, tilt the patients head back slightly, and inspect for
proptosis (unilateral or bilateral).

Move to the front of the patient, and inspect the eyes and periorbital area for lid
retraction, pale conjunctiva, periorbital oedema, lateral eyebrow loss

Assess the extra-ocular muscle function

Instruct the patient to follow your finger in an H shape, keeping their head
still
Ask them to report any double vision
On downwards movement of the eyes, assess for lid lag
Assess convergence
Move your finger in towards the patients nose; ask the patient if this is
painful or elicits double vision

By Jonathan Trobe, M.D. - University of Michigan

Kellogg Eye Center (The Eyes Have It) [CC BY 3.0],
via Wikimedia Commons

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 Fig 2 – Proptosis and lid retraction in thyroid eye
disease.

The Face and Head

Inspect the face for flushing or a ‘peaches and cream’ appearance
Inspect the head for alopecia or hair thinning

The Neck
Inspect the neck from the front and the side for
Size and shape
Scars from previous surgery
Ask the patient to take a sip of water and look for movement of the gland
The gland should move upwards around 1 or 2 fingers with each the
swallowing action

Palpate the thyroid gland

Positioning yourself behind the patient, start at the midline, move your
hands inferiorly to pass over the thyroid cartilage, until you feel the cricoid
cartilage and the two inferior tracheal rings (the thyroid and thyroid isthmus
overlies this region)
Using the pads of your fingers, gently pass them over this area to palpate
the isthmus and thyroid lobes.
The thyroid gland is normally palpable in 50% of women, and 25% of men

Palpate the lymph nodes in the neck

Submental, submandibular, pre-auricular, anterior cervical, supraclavicular,
posterior cervical, post-auricular, and occipital
Feel for any tracheal deviation
Percuss down the sternum for any retrosternal dullness
Retrosternal dullness suggests potential ectopic glandular tissue

Auscultate the gland; ask the patient to hold their breath and listen for any bruit

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 By TeachMeSeries Ltd (2020)

Fig 3 – Stand behind the patient to palpate the thyroid

gland.

The Legs
Inspect the shins for pretibial myxedema

Elicit the patellar reflex (assess for any hyper- or hypo-reflexia)

Perform the sit-to-stand test
Ask the patient to cross their arms and stand from their chair without using
their arms
Assesses for proximal myopathy

To Complete the Examination

Remember, if you have forgotten something important, you can go back and complete
this.

To finish the examination, stand back from the patient and state to the examiner that to
complete your examination, you would like to:

Inspect the chest for signs of gynaecomastia

Perform a cardiovascular examination (especially for atrial fibrillation or systolic
flow murmurs)

Take a blood pressure reading

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