Inspection
Tip the patient’s head slightly back, and carefully inspect the anterior neck. If visible, the thyroid appears between the cricoid cartilage and suprasternal notch. Check for symmetry, diffuse swelling, and obvious masses.
Have the patient swallow, and observe as the cricoid cartilage, thyroid cartilage, and thyroid gland move up and down.
Palpation
Although the thyroid can be palpated from either anterior or posterior positions, the latter approach is traditional.
Ask the patient to slightly flex the neck to relax the sternomastoid muscles.
From behind the patient, reach around with both hands and use your fingers to identify the landmarks from top to bottom: mobile hyoid bone just beneath the mandible, thyroid cartilage with its superior notch, cricoid cartilage, tracheal rings, and suprasternal notch.
Ask the patient to swallow as before, and feel for the thyroid isthmus rising up under your finger pads. It is not always palpable. Feel for size, shape, and consistency, noting any nodules or tenderness.
Hands
Dry skin, increased sweating and palmar erythema can be surveyed as symptoms of thyroid diseases.
Pulse
Assess the radial pulse for Tachycardia (hyperthyroidism), Bradycardia (hypothyroidism), and Irregular – thyrotoxicosis.
Eyes
Inspect for any redness / inflammation of the conjunctiva.
Bilateral exophthalmos is associated with Graves’ disease, caused by abnormal connective tissue deposition in the orbit and extra-ocular muscles.
Lid retraction (the visibility of sclera above the iris) is also a sign for Graves’ disease.
Observe for restriction of eye movements & ask the patient to report any double vision or pain. Eye movement can be restricted in Graves’ disease due to abnormal connective tissue deposition in the orbit and extra-ocular muscles.
