1.

Greeting
Wash your hands.
Introduce yourself to patient.
Confirm patient details
Explain examination
Ask consent from patient.
Inspection Hypothyroidism Hyperthyroidism
Appearence • Agitated?
• Anxious?
• Fidgety?
Hands • Thyroid acropachy (Graves’)
• Peripheral tremor-put piece of paper on
the hand
Palm • Dry skin • Palmar erythema
• Sweat
Pulse rate • Decrease • Increase
• Irregular-atrial fibrillation
Face • Dry skin • Sweating
• Loss of outer third eyebrow
Eyes • Inspect for exophthalmos (Graves’)
• Lid retraction (sclera visible above the
iris)
• Inspect for anterior displacement of the
eye out by look at the side and behind
Eye movement (H • Observe for restriction of eye movement
test) • Access for lid lag
Close inspection • Skin changes-erythema
of neck • Scars-thyroidectomy
• Masses-goitre/ lymph node
Ask patient to • Observe the movement of any masses when swallowing
drink some water
Ask patient to • Observe the movement of any masses
protruded their • No movement
tongue o thyroid gland mass
o Lymph node
• Upward movement
o Thyroglossal cyst
Palpatation • Ask patient to flex their neck slightly forward and relax
• Began palpation at the thyroid cartilage (Adam’s apple)
• As we move downward, you will reach superior edge of cricoid cartilage
• Below cricoid cartilage is the isthmus of thyroid gland
• Palpate the isthmus and then assess each thyroid lobe individually
• Ask patient to protrude their tongue (thyroglossal cyst)
• Ask patient to swallow and assess symmetry of thyroid lobe elevation (asymmetry may
suggest unilateral thyroid mass)
• Palpate local LN for evidence of lymphadenopathy (thyroid malignancy)
Asses for tracheal • Put your hand the bottom of neck
deviation (large
goitre)
Percussion • Percuss to detect any retrosternal dullness (large goitre extending inferiorly)
Auscultation • Auscultate each lobe of the thyroid listening for the thyroid bruit (increase vascularity
secondary to Graves’ disease)
Special Test
Reflex in the arm • Hyporeflexia
• Use the reflex hammer the antecubital fossa
Look at the shin • Inspect the pre-tibial myxodema (Graves’
disease)
Assess for • Proximal myopathy by close arm and
proximal stand up.
myopathy
Last Thanks, the patient and wash hand