student's check list for thyroid examination for reference purposes only

1. 1. Initial Etiquettes
I. Greet and Introduce yourself
II. Assure confidentiality ; respect patient privacy and Comfort
III. Explain procedure to patient and ask for consent
IV. Be polite: say “please” & “thank you”
V. Clean and warm your hands.
VI. Position examiner: Inspection: Right side of patient.
2. Equipment required
1. Simulated patient
OR
Thyroid manikin
2. Hand sanitizer
3. watch
4. Disposable gloves
5. Weighing machine
6. Water bottle
7. Plain paper
8. Measuring tape.
Position of patient : Sitting
Approach: Inspection 1: Anterior 2: Lateral
Palpation 1: Posterior
2: Anterior: I: Lahey’s method II: Crile's method
3: General Examination
Look for. VDAAASH  Voice sound normal: husky, monotonous
 Demeanour ,mental state
 Abnormally hyper- or hypoactive
 Appearance e. g centralobesity
 Appear sweaty?
 Skin: Vitiligo, non-pitting edema
 Hair: Thin, frontal baldness, Hirsuitism.
..Hand :SPPTNP  Large sweaty fleshy hands
 Palmar erythema (hyperthyroidism)
 Pigmentation of hand crease
 Tremor : fine or coarse
 Nails: Acropachy (similar to clubbing), or Onycholysis (nail
comes away from the nail bed).
 Pulse: Tachy, bradycardia...
Thyroid Examination check list for student’s reference

2. Face,
Neck
& Chest
Face :
 Features of Cushing syndrome & acromegaly
Neck:
 Neck swelling (goitre)
 Cervical lymph nodes
 Obvious abnormalities, scars or swellings..
Breasts:
 Gynaecomastia
 Galactorrhoea..
Eyes
 Redness
 Strabismus
 Exophthalmos
 Ophthalmoplegia
 Visual field defect
 Lid lag
 Preorbital edema
 Lid retraction
 Proptosis
..Arms & legs Muscles power :
 Proximal myopathy
Pretibial myxoedema
Tendon reflexes :
 Hypo or hyperreflexia
Genitalia  Virilization
 Testicular volume
 Pubertal development
4: Examination of the Thyroid Gland
Inspection
1: Anterior approach  Skin changes: Erythema, ulceration,…
 Scars: Previous surgeries, post infection…
 Pulsation: Carotid pulsation
 Mass: Ask the patient to swallow sip of water thyroid mass
moves upwards
I: Midline neck
swelling
 No movement :Thyroid gland mass or lymph node
 Upward movement: Thyroglossal cyst
2: Lateral approach:

3. Palpation of thyroid gland
1: Posterior approach
2: Anterior approach
Ask if the patient feels tenderness /pain
1: Lahey’s method
2: Crile's method
Comment on the thyroid gland
1. Size
2. Position
3. Attachment
4. Consistency
5. Edge
6. Surface and shape
7. Pulsations:
8. Inflammation
9. Transillumination
Percussion
Over manubrium sterni : retrosternal extension
Auscultation
Systolic bruit: Primary toxic goitre
Neck circumference :
To monitor the growth rate of swelling
5: Cover the part and Thank the simulator