Thyroid Exam

1. Inspection

1. Tip the patient's head slightly back, and carefully inspect the anterior neck. If visible, the thyroid appears between the cricoid cartilage and suprasternal notch. Check for symmetry, diffuse swelling, and obvious masses.
2. Have the patient swallow, and observe as the cricoid cartilage, thyroid cartilage, and thyroid gland move up and down.

2. Palpate

Although the thyroid can be palpated from either anterior or posterior positions, the latter approach is traditional.

1. Ask the patient to slightly flex the neck to relax the sternomastoid muscles.
2. From behind the patient, reach around with both hands and use your fingers to identify the landmarks from top to bottom: mobile hyoid bone just beneath the mandible, thyroid cartilage with its superior notch, cricoid cartilage, tracheal rings, and suprasternal notch.
3. Place your index fingers just below the cricoid cartilage.
4. Ask the patient to swallow as before, and feel for the thyroid isthmus rising up under your finger pads. It is not always palpable. Feel for size, shape, and consistency, noting any nodules or tenderness.
5. Using the fingers of your right hand, gently move the trachea to the left and feel for the right lobe in the space between the trachea and sternomastoid muscle.
6. Similarly examine the left lobe.
7. If a goiter is detected, listen for a bruit by placing the stethoscope over the lateral lobes.