Escolar Documentos
Profissional Documentos
Cultura Documentos
Key Points
10-2
Key Points
10-3
For the frontal approach, face the patient who is seated on the exam table. Then
follow these four steps.
o First, place your thumb over the trachea about 3 cm below the thyroid
cartilage.
o Second, feel for the isthmus of the gland as the patient swallows.
o Third, palpate the left lobe by pressing the trachea to the left with your left
thumb and placing the first three fingers of your right hand in the thyroid bed
with your fingertips medial to the margin of the sternocleidomastoid muscle.
When the patient swallows, feel for the gland to move.
o Fourth, palpate the right lobe by moving your hands to the opposite
corresponding positions.
For the approach from behind, stand behind the patient who is seated in a chair.
Then follow these four steps.
o First, place two fingers of each hand on the sides of the trachea just beneath
the cricoid cartilage.
o Second, feel for the isthmus of the gland as the patient swallows.
o Third, palpate the left lobe by displacing the trachea to the left with your
right fingers and placing the first three fingers of your left hand medial to the
left sternocleidomastoid muscle. When the patient swallows, feel for the gland
to move.
o Fourth, palpate the right lobe by moving your hands to the opposite
corresponding positions.
Using either approach, palpate the thyroid glands size, shape, configuration, and
consistency and note any tenderness or nodules. If youre not sure whether
youre feeling the thyroid gland, remember that the thyroid gland moves with
swallowing; subcutaneous fat mimicking a goiter does not.
If felt, the thyroid lobes should be small, smooth, firm, pliable, and free of
nodules. The gland should rise freely with swallowing and should be about 4 cm
wide.
If the thyroid gland is enlarged, auscultate it for bruits using the bell of the
stethoscope.