Can you palpate the thyroid gland

Figure 1. Anatomy of the thyroid gland. Illustration of the location and anatomy of the thyroid gland with respect to the neck structures. Thyroid disease rarely manifests as a palpable goiter in isolation.

Thyroid hormones serve to maintain homeostasis primarily by stimulating cellular metabolism throughout the body. Thus, hypo and hyperthyroidism are associated with a range of symptoms and physical findings Table 1. It is important to note that goiters may be euthyroid normal thyroid hormone levels , hyperthyroid, or hypothyroid.

Headaches or visual disturbances may suggest a secondary thyroid disorder due to a pituitary adenoma. Table 1. Symptoms and physical findings for hypo- and hyper-thyroidism.

Although the thyroid can be palpated from either anterior or posterior positions, the latter approach is traditional. The thyroid physical examination is helpful for a clinician as it aids in narrowing down the differential diagnoses related to its anatomical pathology. The thyroid gland produces the thyroid hormones, which serve to maintain homeostasis throughout the body, primarily by stimulating cellular metabolism.

Knowledge of the thyroid gland's location and function is essential for diagnosing the commonly encountered pathologies, which are associated with its malfunctioning. The assessment of this gland should proceed in a systematic fashion, and this video will show the steps of this physical examination in detail.

The first step in examining the thyroid is to correctly locate it and understand its function, so before demonstrating the steps, let's briefly review thyroid anatomy and physiology. The thyroid gland is located in the neck, anterior to the trachea between the cricoid cartilage and the suprasternal notch. The normal gland weighs g, and is usually invisible on inspection and often difficult to palpate.

Conversely, a goiter, which is an enlarged thyroid, is visible and palpable. In addition to assessing the goiter's size, one must also palpate it for its shape, mobility, consistency, and tenderness. Symmetrical enlargement of a soft, smooth thyroid suggests endemic hypothyroidism due to iodine deficiency or one of two autoimmune disorders: Grave's disease or Hashimoto's thyroiditis Thyroid tenderness may be associated with the latter two conditions.

It should be noted that a goiter might be euthyroid, which indicates normal thyroid hormone levels, hyperthyroid, or hypothyroid.

However, hyperthyroidism or hypothyroidism rarely manifests as a palpable goiter in isolation. Therefore, diagnosing thyroid disease requires a detailed understanding of the symptoms and physical exam findings associated with these conditions. Other than goiter, thyroid nodules may also be palpable.

These are common and usually incidental. Now that you have an idea of the structure and function of the thyroid gland, let's go over the sequence of inspection and palpation steps for a thorough evaluation of this vital organ. Before the exam, thoroughly sanitize your hands using a disinfecting solution in view of the patient.

Briefly explain the procedure you will perform. Begin with inspection. To identify lid retraction inspect the eyes from the front and note if sclera is visible between the upper lid margin and the corneal limbus this indicative of lid retraction.

Eyelid retraction is thought to occur due to sympathetic hyperactivity causing excessive contraction of the superior tarsal and levator palpebrae superioris muscles.

To identify exophthalmos, inspect the eye from the front , the side and from above. Exophthalmos is bulging of the eye anteriorly out of the orbit. Inspect for evidence of inflammation affecting the eyes. Due to lid retraction and exophthalmos, the eye is more prone to dryness and the development of conjunctival oedema chemosis , conjunctivitis and in severe cases corneal ulceration. Assess for evidence of ophthalmoplegia e. Ask the patient to keep their head still and follow your finger with their eyes.

Observe for restriction of eye movements and ask the patient to report any double vision or pain. Lid lag refers to a delay in the descent of the upper eyelid in relation to the eyeball when looking downward.

Lid lag is thought to occur secondary to a combination of lid retraction and exophthalmos. Hold your finger superiorly and ask the patient to follow it with their eyes , whilst keeping their head still. Inspect the midline of the neck from the front and the sides noting any masses e. The normal thyroid gland should not be visible.

If a mass is identified during the initial inspection, perform some further assessments to try and narrow the differential diagnosis. Stand behind the patient and ask them to tilt their chin slightly downwards to relax the muscles of the neck to aid palpation of the thyroid gland.

Place the three middle fingers of each hand along the midline of the neck below the chin. Move your fingers inferiorly until you reach the cricoid cartilage. The first two rings of the trachea are located below the cricoid cartilage and the thyroid isthmus overlies this area.

Palpate each lobe of the thyroid in turn by moving your fingers out laterally from the isthmus. Ask the patient to swallow some water, whilst you feel for the symmetrical elevation of the thyroid lobes asymmetrical elevation may suggest a unilateral thyroid mass.

Ask the patient to protrude their tongue if a mass represents a thyroglossal cyst, you will feel it rise during tongue protrusion. If a thyroid mass is noted assess its position , shape , consistency and mobility i. Thyroglossal cysts are the most common congenital abnormality of the neck and arise as a result of the persistence of the thyroglossal duct.

The thyroglossal duct is the tract by which the thyroid gland descends during embryological development to its final position in the front of the neck.

The tongue is attached to the thyroglossal duct , which is why thyroglossal cysts rise during tongue protrusion. Assess for local lymphadenopathy which may indicate the metastatic spread of primary thyroid malignancy.

Position the patient sitting upright and examine from behind if possible. Ask the patient to tilt their chin slightly downwards to relax the muscles of the neck and aid palpation of lymph nodes.

You should also ask them to relax their hands in their lap. Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue to assess the various characteristics of the lymph nodes.

By using both hands one for each side you can note any asymmetry in size, consistency and mobility of lymph nodes. Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland. Palpation: 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. See Evidence Base and Differential Diagnosi s. Half of the thyroids glands examined by ultrasound or direct visualization surgery or autopsy have nodules.

Nodules increase in frequency with age and are four times more likely in women than men. Lumps in the neck can be caused by thyroid disease, and they can also be caused by a variety of other conditions, such as: Lymph node enlargement Lymphoma An infectious abscess A traumatic injury In general, a neck check is not considered the most accurate or reliable way to identify thyroid disease.

Stand in front of a mirror Stand in front of a mirror so that you can see your neck. Extend your neck back Gently extend your neck back. Take a sip of water With your neck slightly extended back, take a sip of water and swallow. Look for enlargements as you swallow As you swallow, look for any: Enlargements Lumps Protrusions Anything that is off-center It is a good idea to repeat the process again. Feel for bumps and enlargement Gently touch the area around your thyroid gland to try to palpate or feel any enlargement, bumps, or protrusions.

To tell the difference between the thyroid and the other structures of your neck: Slide your finger down the midline of your neck. The first hard structure you will hit is the thyroid cartilage leading to the Adam's apple. As you continue to move your finger downward, you will next encounter another bit of cartilage called the cricoid ring. This encircles the trachea , also known as your windpipe. Two fingers-width below this is the thyroid isthmus.

This is the tissue that connects the two sides of the gland. Your thyroid gland's lobes are on either side of the thyroid isthmus. Follow up with your healthcare provider If you find lumps or protrusions of any sort, you should definitely let your healthcare provider know.

Thyroid Disease Healthcare Provider Discussion Guide Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. Download PDF. Email the Guide Send to yourself or a loved one. Sign Up. Was this page helpful?

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