1. Introduction
The thyroid examination looks for structural thyroid disease and peripheral signs of thyroid dysfunction. It is commonly tested in undergraduate OSCEs because it combines endocrine signs with focused neck examination.
2. General inspection
Inspect the patient from the front for agitation, sweating, cachexia, hoarse voice and an obvious goitre or neck scar. Ask the patient to swallow a sip of water and watch whether a neck swelling moves upwards with swallowing.
3. Hands, face and pulse
Inspect the hands for warm, sweaty palms, tremor, thyroid acropachy and nail changes such as onycholysis. Assess the pulse for rate and rhythm. Examine the eyes for lid retraction, lid lag, proptosis, conjunctival injection and ophthalmoplegia.
4. Thyroid gland examination
Inspect the neck carefully and ask the patient to protrude the tongue if a thyroglossal cyst is part of the differential, as this classically moves with tongue protrusion. Palpate the thyroid from behind, assessing size, surface, consistency, tenderness, nodules and whether the lower border can be felt. Percuss the sternum if retrosternal extension is suspected and auscultate for a bruit in a large toxic goitre.
5. Completion
Check for proximal myopathy and brisk reflexes if hyperthyroidism is suspected. Summarise the findings and suggest thyroid function tests and ultrasound when appropriate.
Preparation
General inspection
Inspection
Hands
Eyes
Neck
Palpation
Percussion
Auscultation
Completion