examination of thyroid gland

2. The examination consists of three portions:
 Inspection,
 Palpation, and
 Synthesis of data from these techniques

3. AGE:
Puberty- simple goitre,papillary
carcinoma,
Middle age- multinodular goitre,colloid goitre,
follicular carcinoma.
Old age- Anaplastic carcinoma

4. SEX:
Simple goitre is more common in Females
thyrotoxicosis is 8 times more common in females.
Thyroid carcinoma is more often seen in females
3:1.
OCCUPATION:
Thyrotoxicosis is common in people working under
stress and strain.
.

5. RESIDENCE:
Goitre belts in india like Himalayas, Vindyas,
Satpuda ranges. Areas producing chalk or lime
stone like Derbyshire

6. SWELLING;
DURATION;
ASSOCIATED PAIN;

7. 1.DESCRIBE IN DETAILS ONSET AND
PROGRESSION OF THE SWELLING,
2.PRESSURE EFFECTS;
3.SYMPOTOMS OF HYPOTHYROIDISM
4.SYMPOTOMS OF HYPERTHYROIDISM;
5.SYMPTOMS OF MALIGANANCY.

8.  Tilt the patients head back a bit
 Use tangential lighting from the tip of the
patients chin
 Ask for swallowing
 Observe the thyroid cartilage, cricoid cartilage
and the thyroid gland raising with swallowing

9. Inspection: Anterior Approach
 The patient should be seated or standing in a
comfortable position with the neck in a neutral or
slightly extended position.
 Cross-lighting increases shadows, improving the
detection of masses.
 To enhance visualization of the thyroid, you can:
 Extending the neck, which stretches overlying
tissues
 Have the patient swallow a sip of water, watching
for the upward movement of the thyroid gland.

10. Inspection: Lateral Approach
 After completing anterior inspection of the
thyroid, observe the neck from the side.
 Estimate the smooth, straight contour from
the cricoid cartilage to the suprasternal notch.
 Measure any prominence beyond this
imagined contour, using a ruler placed in the
area of prominence.

11. • Size : ……X………..
• Shape : Ovoid / Spherical / Irregular
• Location: One side / mid line / both sides of
mid line
• Extent: Horizontal from Sternomastoid…
Vertical from Suprasternal Notch…
The swelling is: Under Sternomastoid / Not
under sternum
• Surface: Smooth / Nodular / Bosselated

12. • Skin over the swelling:Redness and edema, Scars
of previous surgery, Sinuses, Dilated veins
• Pulsatility : Present / Absent
• Movement with Deglutition: Present / Absent
• Protrusion of Tongue (For midline swellings):
Present / Absent

13. Do not press to
much the thyroid
You can loose the
sensitivity of your
fingers
Try to not
strangle your
patient

14. The following information could be obtained
 volume
 consistency
 mobility of the thyroid gland
 surface
 temperature

15.  Palpate the thyroid gland from behind
 Localize anatomic boundaries
 Thyroid isthmus is often palpable
 Thyroid lobes are barely or not palpable
 The consistency is rubbery, similar to that of sternomastoid
muscle

16.  Temperature: Normal / Raised
 Tenderness : Present / Absent
 Size: … X …
 Shape: Ovoid / Spherical / Irregular
 Extent: Horizontal from Sternomastoid…
Vertical from Suprasternal Notch…
 Plane of the swelling : Under Sternomastoid /
Under Strap muscles/ Deep to deep fascia.

17. A) In case of affection of entire gland,
• i) Surface : Smooth / Bosselated
• ii) Consistency : Uniform (Soft / Firm / Hard) /
Variable
• iii) Retrosternal Extension : Present / Absent
B)In case of Single Nodule Or One Lobe affection
• i) Location : Lobe / Isthmus
• ii)Consistency: Soft / Firm
• iii) Is the rest of the gland palpable ? Yes / No

18. • Stand behind the pt.
• Place your hands around the neck with the thumbs over the
occiput and tips of the other fingers over the front of the neck.
• Flex the neck to relax deep cervical fascia.
• Ask the pt to swallow to look for lower border and nodules.
• To palpate anterior surface, incline the head to the side being
examined to relax overlying sternomastoid muscle.

19. Palpation: Anterior Approach
1. The patient is examined in the seated or
standing position.
2. Attempt to locate the thyroid isthmus by
palpating between the cricoid cartilage
and the suprasternal notch.
3. Use one hand to slightly retract the
sternocleidomastoid muscle while using
the other to palpate the thyroid.
4. Have the patient swallow a sip of water as
you palpate, feeling for the upward
movement of the thyroid gland.

20. Palpation: Posterior Approach
1. The patient is examined in the
seated or standing position.
2. Standing behind the patient,
attempt to locate the thyroid
isthmus by palpating between
the cricoid cartilage and the
suprasternal notch.
3. Move your hands laterally to try
to feel under the
sternocleidomstoids for the
fullness of the thyroid.
4. Have the patient swallow a sip
of water as you palpate, feeling
for the upward movement of the
thyroid gland.

21.  Stand in front of the patient.
 Extend the neck slightly.
 Keep a thumb over the lobe to be examined.
 Ask the pt to swallow. Feel for small nodules.

22. • In short and flat neck ————Pizillo’s Method
makes gland prominent
• Ask pt to clasp his hands over the occiput
• Push the head backwards against the resistance
of the clasped hand

23.  Done to palpate deep or postero medial surface
of the gland.
 Stand in front of the patient.
 Extend the neck slightly.
 Push the thyroid gland laterally to displace it
from tracheo esophageal groove.
 Palpate the posterior surface for nodules with
other hand.

24. • Done in large, bilateral goiter to rule out tracheal
narrowing.
• Extend the neck.
• Ask the patient to take deep breaths through the
mouth.
• Compress the swelling from both the sides.
• Appearance of stridor with slight compression of
lateral lobes due to Narrowing of trachea ( Scabbard
trachea).it is seen in case of large and longstanding
multinodular goiter and Ca thyroid infiltrating
trachea.

25.  Lahey’s Method of Palpation of Thyroid: Nodules
Present / Absent,If present consistency of nodule
 Crile’s Method of Palpation of Thyroid: Nodules
Present / Absent
 Palpabale Thrill : Present / Absent
 Fixity to skin : Fixed / Not Fixed
 Mobility : Horizontally Mobile / Fixed ;Vertically
Mobile / Fixed
 Palpation of Trachea : Palpable / Not Palpable,
Deviated / Not deviated
 Kocher’s Test : Positive / Negative
 Palpation of carotids : Berry’s Sign Positive / Negative

26. Percussion over sternum : Resonant / Dull
Ascultaion of gland : where to ascultate? Lower
pole or Upper pole? why?

27.  Hoarseness of voice : Present / Absent
 Edema of face and legs: Present / Absent
 Delayed relaxation of deep reflexes : Ankle
jerk ,Knee jerk
 History of lethargy: Present / Absent

28.  Dilated veins : Present / Absent
 Congestion and puffiness of face: Present / Absent
 Palpate for tracheal rings: Present / Absent
 Percuss over sternum: Resonant / Dull
 Pemberton’s sign: Positive / Negative
 Horners syndrome: (Ptosis,Constricted pupil,
Enophthalmos, Absent cilio-spinal reflex, Anhydrosis)
: Present / Absent

29.  Eye signs
 Lid retraction : Dalrymple’s sign : Present / Absent
 Lid lag : Von Graeffe’s sign: Present / Absent
 Incomplete, infrequent blinking: Stellwag’s sign : Present /
Absent
 Exophthalmos : strip of sclera under inf limbus: Present /
Absent
 Naffziger’s Method : Present / Absent
 Wrinkling of forehead : Joffroy’s sign : Present / Absent
 Eversion of upper eye lid : Gifford’s sign: Positive / Negative
 Convergence : Mobius’ sign : Present / Absent
 Chemosis: Congestion and edema of conjunctiva,
 Corneal ulcers, diminished vision , Ophthalmoplegia

30.  To note the amount and the degree of
exophthalmos.
 Stand behind the patient.
 See from above.
 Observe the eyes in supraorbital plane,if corneal
limbus is visible then it is exophthalmos.

31.  Tremors : Outstretched Hand : Present / Absent
 Protruded tongue: Present / Absent
 Tachycardia : Heart rate = …. Bounding pulse:
Present / Absent
 Warm and moist skin : Present / Absent
 Pretibial Myxoedema : Present / Absent
 Bruit, Thrill: Present / Absent

32.  Neck : Enlarged and hard lymph nodes.
 Skull surface : Hard nodules.
 Long bones : Deformity and tenderness.
 Chest : Effusion and consolidation.
 Abdomen : Nodular Liver and ascites.

33.  Berry’s sign: Palpate the Carotid pulsations
against the transverse process of the 6th cervical
vertebra b/w post border of thyroid and
sternomastiod.
 In Ca thyroid, Carotid pulsations is weak or
absent. Due to Infiltration of carotid sheath .
 In benign goiter pulsations are well felt as carotid
sheath pushed backwards.