ABSTRACT
Establishes how long the swelling has been present and whether it has changed over time Enquires about any local effects of the swelling, in particular pain, difficulty swallowing and difficulty breathing Enquires about systemic effects of thyroid disease – change in weight, extreme preference for hot/cold temperatures, change in bowel habit, lethargy and change in mood Asks if patient is currently in any pain
Examination
Inspects from the end of the bed for signs of thyroid disease Inspects neck from the front and side, commenting on the presence/absence of surgical scars, asymmetry and any obvious swellings Inspects for movement of swelling whilst patient takes a sip of water Palpates swelling Palpates for movement of swelling whilst patient takes a sip of water Palpates for cervical lymphadenopathy Assesses for tracheal deviation Auscultates over swelling for thyroid bruit Measures radial pulse rate Examines hands for sweatiness, palmar erythema, thyroid acropachy and a postural tremor Examines eyes for lid lag and ophthalmoplegia Assesses for proximal myopathy
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY Start the examination with a general inspection for signs of thyroid disease. Look at the face for the presence of peri-orbital puffiness and loss of the outer third of the eyebrows, and observe whether the skin is dry or shiny and the hair coarse/dry/thinning. Note your patient’s build and also whether he/she is dressed appropriately for the temperature. The presence of any of these signs will be clues to the differential diagnosis, and if they fit the rest of your examination, should be included in your presentation.
