Introduction

Examining for the signs of thyroid disease is an important clinical skill. This examination encompasses a wide range of different parts of the body for the systemic signs of thyroid disease.

Examination

Basics

  • Wash Hands
  • Introduce yourself
  • Confirm the identity of the patient
  • Ask for the patient consent – explain what you are going to do, for example:
    • Today I’d like to examine you for signs of thyroid problems. This involve we feeling your neck, checking your pulse, checking your hands and checking your eyes… “

General Inspection

  • Signs of hyperthyroidism
    • Anxiety / agitations / restlessness
    • Sweaty
    • Bulging eyes (exophthalmost – aka proptosis)
  • Signs of hypothyroidism
    • Goitre (maybe obvious from across the room)
    • Appears cold (e.g. wearing extra layers of clothing)
    • Hair loss
    • Overweight
    • Dry skin

Hands

Look

  • Tremor- best assessed by simply placing a piece of A4 paper rested across the back of outstretched hands – does the paper appear to vibrate or wiggle?
  • Palms
    • Erythema – suggests hyperthyroidism
    • Dry skin – suggests hypothyroidism

Feel

  • Temperature – warm or cool?
  • Clammy / sweaty?
  • Pulse – regular or irregular
    • AF is associated with hyperthyroidism
    • May be fast in hyperthyroidism
    • May be low in hypothyroidism

Face

Look

  • Dry skin, hair loss, dry brittle hair – hypothyroidism
  • Sweaty – hyperthyroidism
  • Eyes
    • Bulging eye – exophthalmos – hyperthyroidism
      • Check from the front and from the side
    • Eye movements
      • Ask the patient to follow your finger with their eyes, whilst keeping the head still. Start at the upper extremity of gaze and move downwards towards the lower extremity of gaze
      • Lid lag occurs when the upper eyelid does not follow the downward movement of the eye immediately and is instead perceptibly delayed, often in a jerky fashion

Neck

Look

  • Any obvious swelling or mass?
  • Any scars (from previous surgery?)

Swallow Test

Observe for any movement of massess