A

• Auscultation of Thyroid

  • Definition: Listening over the thyroid gland with a stethoscope for vascular sounds (bruits).

  • Clinical significance: Presence of a bruit suggests increased blood flow, commonly seen in hyperthyroidism (e.g., Graves’ disease).

• Asymmetry

  • Observation: Unequal size or shape of thyroid lobes.

  • Significance: May indicate nodules, cysts, or malignancy.

B

• Brisk Reflexes

  • Definition: Hyperactive deep tendon reflexes often seen in hyperthyroidism.

  • Examination: Test the biceps, triceps, or ankle reflexes.

C

• Consistency (of thyroid gland)

  • Normal: Soft and smooth.

  • Firm or hard: Suggests fibrosis or malignancy.

  • Tenderness: Can indicate thyroiditis.

• Cold Nodule

  • Definition: On thyroid scans, areas that do not uptake isotope.

  • Clinical note: Usually non-functioning; higher risk of malignancy, but this is from imaging, important to suspect on examination if firm nodule present.

• Crackles (Chest Exam relevance)

  • Not directly thyroid exam but assess for heart failure signs, sometimes seen in severe hypothyroidism.

D

• Diffuse Enlargement

  • Description: Uniform thyroid swelling without distinct nodules.

  • Common causes: Graves’ disease, Hashimoto’s thyroiditis, iodine deficiency.

E

• Erythema and Warmth over Thyroid

  • Indicates: Acute thyroiditis or inflammation.

F

• Firmness

  • Definition: Feeling of the gland on palpation.

  • Implication: Firm or hard glands suggest malignancy or fibrosis.

G

• Goitre

  • Definition: Enlargement of the thyroid gland, visible or palpable.

  • Types: Diffuse, multinodular, solitary nodule.

  • Assessment: Size, shape, consistency, mobility.

H

• Hard Nodule

  • Concern: May indicate malignancy.

  • Examination: Palpate nodules for size, mobility, tenderness.

• Hypothyroid Signs on Exam

  • Dry skin, coarse hair, bradycardia, delayed relaxation phase of reflexes.

I

• Inspiratory Retraction

  • Definition: Visible inward movement of the suprasternal notch or lower neck on inspiration.

  • Significance: Large goitre causing airway obstruction.

L

• Lymphadenopathy

  • Definition: Enlarged cervical lymph nodes near the thyroid.

  • Significance: Suggests malignancy or infection.

M

• Mobility of Thyroid Gland

  • Normal: Moves upward on swallowing due to attachment to the trachea.

  • Fixation: Suggests invasive malignancy.

• Multinodular Goitre

  • Definition: Thyroid with multiple nodules; may be large and irregular.

N

• Nodules

  • Palpable lumps within the thyroid.

  • Features to note: Size, number, consistency, tenderness, mobility, associated lymphadenopathy.

  • Clinical importance: Some nodules may be malignant; others benign or cystic.

P

• Pemberton’s Sign

  • Test: Patient raises arms above the head for 1-2 minutes.

  • Positive sign: Facial flushing, cyanosis, or respiratory distress due to compression of thoracic inlet by a large goitre.

• Pulse (Thyroid exam relevance)

  • Observation: Tachycardia may be present in hyperthyroidism.

• Periorbital Edema

  • Seen in: Hypothyroidism (myxedema).

R

• Retrosternal Extension

  • Definition: Goitre extends into the thoracic inlet, not easily palpable but causing compressive symptoms.

  • Clues: Dysphagia, dyspnea, hoarseness.

S

• Size (of thyroid)

  • Assessment: Measure by palpation; use inspection for visible enlargement.

  • Normal: Not visible or only a slight prominence on swallowing.

• Skin Changes

  • Thin, warm, moist skin: Hyperthyroidism.

  • Dry, coarse skin: Hypothyroidism.

• Stridor

  • Audible high-pitched sound on inspiration.

  • Significance: Airway obstruction by large thyroid mass.

T

• Tenderness

  • Pain on palpation.

  • Indicates: Thyroiditis or hemorrhage into cyst/nodule.

• Thyroid Bruit

  • Heard on auscultation.

  • Indicates: Increased vascularity (e.g., Graves’ disease).

• Thyroid Stimulating Hormone (TSH) Testing

  • Lab test: Not part of physical exam but essential to correlate clinical findings.

V

• Voice Changes / Hoarseness

  • Possible cause: Recurrent laryngeal nerve involvement from large goitre or malignancy.

W

• Warmth of Thyroid

  • Increased temperature over gland indicates inflammation or hyperactivity.

Examination Technique Overview

• Inspection: Look for swelling, scars, skin changes, visible pulsations, or asymmetry.

• Palpation: Use both hands to palpate from behind; feel for size, shape, nodules, tenderness, consistency, and mobility on swallowing.

• Auscultation: Listen over the thyroid for bruits with the diaphragm of the stethoscope.

• Special tests: Pemberton’s sign to detect thoracic inlet obstruction.