(On Screen) Clinical Skills Online: St George’s, University of London
The thyroid status assessment and thyroid gland examination
Doctor: So today we’re going to look at the thyroid gland examination and thyroid status assessment.
(To patient) Good afternoon. My name is Dr. Michelle Dabney. I’m one of the doctors here. I’ve been asked today to examine the thyroid gland in your neck and to look at some other areas of the body that are affected by the thyroid gland, is that okay with you?
Patient: That’s fine.
Doctor: Great. So first of all we do a general inspection, looking at things, like whether the patient is appropriately dressed for the temperature, whether they are over or under weight, whether they appear anxious or agitated. We look at things in the face, in particular whether they’ve got any facial myxedema or peaches and cream complexion as it’s known; looking for any hair loss, particularly loss of the outer third of the eyebrows; and looking for any obvious lid retraction.
So then we can move on to look at the hands.
(To patient) If I could take booth of your hands there…
Looking for thyroid acropachy, looking for onycholysis. Turning the hands over, looking for palm erythema; feeling the palms to feel if they are particularly sweaty or dry.
(To patient) Okay that’s fine. Would you hold your hands out there for me please?
At this point, I’m looking for any fine tremor. And if we’re in any doubt about this, we can rest a piece of paper on top of the hands, which will surely exaggerate for our tremor if it’s there.
(To patient) Okay, that’s fine. Just put your hand down.
Next, we take the patient’s pulse, looking for any tachycardia or feeling for an extra fibrillation.
(To patient) Okay, that’s fine.
And finally, we’re going to inspect the neck from the front, looking front on for any obvious goiter, or thyroid enlargement, or any midline masses. And we can ask the patient to swallow some water while we watch this.
(To patient) If you could take a sip of water and hold it in your mouth…and swallow for me.
Okay, that’s great.
If you see or notice a mass in the midline, you can ask the person to stick their tongue out.
(To patient) Would you stick your tongue out for me? Okay, that’s great.
If it’s a thyroglossal cyst, it will move with the protrusion of the tongue.
So that’s our inspection from in front of the patient. So now we’ll move behind and continue the examination.
So continuing the examination from behind the patient, you can palpate for the thyroid gland. Okay. Then again, ask our patient to take water into his mouth...
(To patient) And hold it there…and swallow for me. Okay.
Feeling for any movement of the thyroid with swallowing. Alright. While we’re there, also check for any [3:23 saliva aphedenopothy]. Ok. Coming around to the side, auscultating for a thyroid [3:41 bruit].
(To patient) Would you take a breath and then hold it for me? And relax.
And same on the other side.
(To patient) Take a breath and then hold it. And relax.
The final part of the thyroid gland examination, if you notice any enlargement is to percuss for any retrosternal extension.
(To patient) Ok.
Once we’re finished doing that, we can start examining for any eye signs, looking at the top of the patient for any proptosis or exophthalmos, any protrusion of the eye beyond that [4:24 inaudible] orbital margin, and again from the side. Okay. Then, we need to move back to the front of our patient again to complete our examination of the eye signs.
So now we move on to examine for any opthalmoplegia.
(To patient) If you could follow my finger with your eyes and, tell me if you see double at any time. Ok.
And then looking specifically for lid lag.
(To patient) Again, follow my finger with your eyes. Ok. That’s great.
There are just a few things left to do to complete our examination. Next, we’ll look for any proximal myopathy.
(To patient) If you could hold your arms up like a chicken, hold them there for me please. That’s great. And then just resting your arms on your legs.
Now checking for reflexes, and then the other side. Okay.
And the last thing left to do is to look for any pretibial myxedema.
When you’re looking pretibial myxedema in the shins, you should also check the patella reflexes in the knee, and screen for proximal myopathy in the lower limbs by asking the patient to stand without the assistance of their arms.
And that completes our examination.