Thyroid Examination

The thyroid gland sits at the front of the neck and produces endocrine hormones into the bloodstream.  Sometimes the gland can produce too much (hyperthyroid) or too little hormone (hypothyroid) which results in a patient needing treatment.  There are certain signs and symptoms that the patient may present with and it is these that you are examining the patient for in this station.

In OSCEs this station may start in a number of ways. You may be given a history of a hyper- or hypothyroid patient, or you may be asked to examine the patient’s neck or thyroid gland. Either way you should approach the situation systematically and not jump straight into feeling the neck.

Subject steps

  1. Perform an initial observation of the patient.

    • Do they seem abnormally hyper- or hypoactive?
    • Do they appear sweaty?
    • What condition is their skin and hair?
    • Does their voice sound normal?

    Report any abnormalities to the examiner.

  2. Palpate the entire length of both lobes of the gland as well as the isthmus. Note any swellings or abnormal lumps. You should note the shape and consistency of any lumps as well as whether they are tender or mobile. You should also examine while the patient drinks to assess whether the lump moves with swallowing.

  3. Thank your patient and report your findings to the examiner. An extension to this station could be thyroid function  results interpretation. Below are the three most common diagnosis:

    Primary Hypothyroidism

    TSH:
    Free T3 and free T4:

    Secondary Hypothyroidism

    TSH: ↓ or ↔
    Free T3 and free T4:

    Hyperthyroidism

    TSH: ↓
    Free T3 and free T4: ↑