Related Subjects:
|Thyrotoxicosis and Hyperthyroidism
|Thyroid Storm - Thyrotoxic crisis
|Graves Disease (Thyrotoxicosis)
|Amiodarone and Thyroid disease
|Thyroid Surgery (Thyroidectomy)
|Hypothyroidism
|Hashimoto's thyroiditis
|DeQuervain's thyroiditis
|Subacute Thyroiditis
|Thyroid nodule
|Congenital Hypothyroidism
|Thyroid Function Tests and antibodies
|Post partum thyroiditis
|Sick Euthyroid Syndrome
|Thyroid Exam (OSCE)
|Thyroid Gland anatomy and Physiology
|Thyroid Cancer
🧾 Always show in exams that you are considering the patient’s thyroid status - hypothyroid, euthyroid, or hyperthyroid - and actively look for nodules (possible malignancy).
🛠 Equipment
- 🩺 Stethoscope
- 📄 Piece of paper (for tremor test)
- 🥤 Glass of water (for swallow test)
- 🔨 Tendon hammer
📋 Thyroid Exam: Overall Plan
- Wash hands, introductions, consent ✅
- Look for overall thyroid status clues (hypo/eu/hyper)
- Inspect neck, eyes, general appearance 👀
- Take pulse (bradycardia, tachycardia, AF) ❤️
- Look for thyroid acropachy (Graves’ disease)
- Palpate thyroid from behind: size, consistency
- Percuss for retrosternal extension 👂
- Auscultate for bruit 🔊
- Swallow test (thyroid mass moves up)
- Tendon reflexes (hypo → slow, hyper → brisk)
- Look at legs for pretibial myxoedema 🦵
- Thank patient, wash hands, present findings
📖 Introduction (WIPER)
- W – Wash hands 🧼
- I – Introduce yourself & confirm patient details
- P – Permission & consent
- E – Expose neck & chest appropriately
- R – Reposition (sitting, examiner in front then behind)
🔍 Inspection: General & Eyes
- Listen for stridor (tracheal obstruction)
- Assess weight, clothing, demeanour
- Voice: hoarse (goitre compression) / slow, slurred (hypothyroid)
📊 Thyroid Status Clues
- 🔺 Hyperthyroid: Slim, sweaty, heat-intolerant, anxious, tremulous
- 🔻 Hypothyroid: Overweight, cold-intolerant, low mood, lethargy, hoarse
✋ Hands
- Pulse: rate + rhythm (tachy/brady/AF)
- Paper test for fine tremor
- Hyper: warm, sweaty, AF, tremor, acropachy, onycholysis
- Hypo: bradycardia, carpal tunnel signs
👁 Face & Eyes
- Hypo: Puffy, pale, dry skin, periorbital oedema, hair loss
- Hyper: Lid lag, lid retraction, flushed moist skin
- Graves’: exophthalmos, chemosis, ophthalmoplegia
🤲 Examining the Neck
- Look: scars (thyroidectomy), goitre, nodules
- Swallow test: thyroid moves up; thyroglossal cyst moves with tongue
- Palpate from behind: size, tenderness, consistency (soft, firm, hard, irregular)
- Check lymph nodes carefully (submandibular, cervical, supraclavicular)
- Trachea: deviation? compression?
- Percuss sternum → retrosternal goitre
- Auscultate for bruit → Graves’ disease
🧪 Special Signs
- Biceps/knee jerk: slow relaxation (hypothyroid), brisk (hyperthyroid)
- Pretibial myxoedema (Graves’)
- Proximal myopathy (difficulty rising from chair)
✅ Completing the Exam
- Thank patient, wash hands
- Summarise findings
- Suggest further: TFTs, ECG, thyroid imaging (USS, isotope scan)
