Thyroid Examination

Present your self to the patient

Take permission

Wash your hand

The patient should be sitting in a chair with good light with the examiner at the same level in a chair or kneeling

Ask for a glass of water

 Exposure of the patient and positioning

Exposure to the level of sternal angle- remove head coverings

Neck should be extended

Hand beside the patient

Remove of neck jewelries

Inspection

Swelling in the anterior aspect of the neck

Size

Shape

Moves with swallowing

Moves with protrution of the tounge

Skin

Scars

Dilated neck veins

Visible pulsation

Palpation

Ask patient for presence of tenderness

From front  do first The 4 T

Tenderness

Temperature

Thrill 

Trachea

From Behind

begin by the largest lobe 

size

Surface

Consistancy

Ability to go below it

Attachment to skin

Ask the patient to look upward and to opposite site 

Examine for attachment to Sternomastoid muscle

Do the the same in the other lobe

Now Examine cervical lymph nodes using up and down technique

palpate for carotid pulsation(Barry's sign)

palpate the scalp for mets

Move infront of the patient 

Percustion for reterosternal extension on each side of the sternum  

Auscultate for the presence of bruit

Examination of The Thyroid Status   

Examination of the Hands

Shake hands the hands for temperature and moisture

Pulse:Rate-Rhythm-Volume

Ask the patient to spread his fingers for fine tremers

look for palmer erythema- clubbing of fingers-brittel nails-thyroid acropachy

Measure the blood pressure

Examination of the Eyes:  look for

Lid retraction

Chemosis 

Corneal ulceration

Exopthalamus

Proptosis(from the sides and behind)

Ask the patient to follow your finger for

Lid lagging

Opthalamoplegia

Jeffery's sign (abscence of wrinkling of the forehead )

Examination of the lower limbs for pretibial mexodema and knee reflexes 

Examination of Cardiovascular system and the abdomen(for hepatomegaly and ascites)

Examination of the voice

Ask the patient to try stand from sitting without support (for proximal myopathy)

Cover the patient

Thank the patient

Wash your Hand