Clinical examination of the

thyroid gland
 Inspect the neck for the thyroid gland
Tip the patients head back a bit.
Using tangential and facing directed
downward from the tip of the patients chin,
inspect the region below the cricoid cartilage
for the gland.
 The lower border of this large
thyroid gland is outlined by
tangential lighting.

Normal :
Thyroid cartilage
Cricoid cartilage
Thyroid gland
 Ask the patient to sip some water and to
extend the neck again and swallow.
The thyroid cartilage, the cricoid cartilage,
and the thyroid gland all rise with swallowing
and then fall to their resting positions.
Watch for upward movement of the
thyroid gland, noting its contour and
symmetry.
 Palpation
Ask the patient to flex the neck slightly forward to relax the
sternomastoid muscles.
Place the fingers of both hands on the patients neck so that your
index fingers are just below the cricoid cartilage.
Ask the patient to sip and swallow water as before. Feel for the
thyroid isthmus rising up under your finger pads. It is often but not
always palpable.
Displace the trachea to the right with the fingers of the left hand;
with the righthand fingers, palpate laterally for the right lobe of the
thyroid in the space between the displaced trachea and the relaxed
sternomastoid. Find the lateral margin.
In similar fashion, examine the left lobe.
The anterior surface of a lateral lobe is approximately the size of the
distal phalanx of the thumb and feels somewhat rubbery.
Note the size, ----
Palpation from the front
 Inspect the trachea for any deviation from its usual
midline position.
Then feel for any deviation.
Place your finger along one side of the trachea and
note the space between it and the sternomastoid.
Compare it with the other side.
The spaces should be symmetric.
Masses in the neck may push the trachea to one side.
Tracheal deviation may also signify important problems
in the thorax, such as a mediastinal mass, atelectasis,
or a large pneumothorax
Lymph node examination
 Relation to the surrounding structure
The Carotid Arteries
Etc .
Percussion
 If the thyroid gland is enlarged,
listen over the lateral lobes with a stethoscope
to detect a bruit.
 Diffuse Enlargement
A diffusely enlarged gland includes the isthmus and the lateral lobes, but there are no discretely nodules.
Causes include Graves disease, Hashimotos thyroiditis, and endemic goiter .
 Multinodular Goiter
This term refers to an enlarged thyroid gland that contains two or more identifiable nodules. Multiple nodules
suggest a metabolic rather than a neoplastic process, but irradiation during childhood, a positive family history,
enlarged cervical nodes, or continuing enlargement of one of the nodules raises the suspicion of malignancy.
 Single Nodule
A clinically single nodule may be a cyst, a benign tumor, or one nodule within a multinodular gland, but it also
raises the question of a malignancy.
Prior irradiation, hardness, rapid growth, fixation to surrounding tissues, enlarged cervical nodes, and
occurrence in males increase the probability of malignancy.
Lid lag
Lid lag