Thyroid Clinical Examination

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18165   3 years ago
samer176 | 2 subscribers
18165   3 years ago
The examination consists of three portions:
Inspection,
Palpation, and
Synthesis of data from these techniques
In addition to palpating for size, also note the gland texture, mobility, tenderness and the presence of nodules.
Inspection
Inspection: Anterior Approach
The patient should be seated or standing in a comfortable position with the neck in a neutral or slightly extended position.
Cross-lighting increases shadows, improving the detection of masses.
To enhance visualization of the thyroid, you can:
Extending the neck, which stretches overlying tissues
Have the patient swallow a sip of water, watching for the upward movement of the thyroid gland.
quicktime video 251KB video demo from Return to the Bedside
Inspection: Lateral Approach
After completing anterior inspection of the thyroid, observe the neck from the side.
Estimate the smooth, straight contour from the cricoid cartilage to the suprasternal notch.
Measure any prominence beyond this imagined contour, using a ruler placed in the area of prominence.
Palpation
Note: There is no data comparing palpation using the anterior approach to the posterior approach so examiners should use the approach that they find most comfortable.
Palpation: Anterior Approach
placement of hands for palpatation of thyroid in anterior approach

The patient is examined in the seated or standing position.
Attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch.
Use one hand to slightly retract the sternocleidomastoid muscle while using the other to palpate the thyroid.
Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland.
quicktime video 454KB video demo from Return to the Bedside.
Palpation: Posterior Approach placement of hands for palpatation of thyroid in posterior approach

The patient is examined in the seated or standing position.
Standing behind the patient, attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch.
Move your hands laterally to try to feel under the sternocleidomstoids for the fullness of the thyroid.
Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland.
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