Examination of ThyroidSection 1

3In this method, the examination of the thyroid is performed from the front. The normal lobe of thyroid is pushed to side of nodule so that the solitary nodule can be made prominent and palpated well

This method involves placing the thumb on the thyroid gland and asking the patient to swallow. Small thyroid nodules within the thyroid gland can be palpated by this method

Bone

Lung

Liver

Soft/Cystic

Firm

Hard

Long-standing goiter with calcification will feel hard

Whether lower border is palpable or not

Flushing of veins over neck and anterior chest, difficulty in breathing

When the carotid artery is engulfed by the tumor, the carotid pulsations may not be felt on palpation suggesting a locally advanced thyroid malignancy

Encasement of the carotid artery

In a patient suspected of tracheal obstruction, pressure on the thyroid lobe against the trachea will produce stridor

Large and/or malignant goiters may involve the sympathetic trunk leading to Horner's syndrome which consists of:

Thrill may be palpable in primary or metastatic follicular cancers

Combination of bilateral exophthalmos, lid retraction stare, and enlarged thyroid

Upper eyelid lag on downward gaze

Lid retraction with scleral show

Bilateral proptosis of more than 22 mm or a difference between the two eyes of > 2 mm is suspicious

Absent forehead creases on superior gaze

Lower lid lag on upward gaze

Deficient convergence

When looking down from behind the patient, the cornea is visible in cases of exophthalmos