Clinically Reviewed by Dr. Andrew Stein MD, Consultant Physician. Last updated: April 2026
A thyroid examination is a specialised assessment used to evaluate the thyroid gland’s structure and the systemic effects of thyroid hormone imbalance (hyperthyroidism or hypothyroidism).
Before touching the patient, set the stage for a professional head-to-toe assessment:
W – Wash: Clean your hands using the WHO 7-step technique.
I – Introduce: State your name and role.
P – Permission & Pain: Explain that you will be examining the neck and checking for signs of thyroid disease on the hands and face. Ask if they have any neck tenderness.
E – Exposure: The patient should have their neck and upper chest fully visible.
R – (Re)position: The patient should sit upright on a chair or the edge of the couch. You will need to move around the patient to palpate from behind.
Thyroid disorders have significant systemic manifestations. Start with the hands and move toward the face.
Hands
Thyroid Acropachy: Clubbing-like changes (rare, associated with Graves’ disease).
Palmar Erythema: Redness of the palms (hyperthyroidism).
Tremor: Place a piece of paper on the back of the patient’s outstretched hands to detect a fine tremor (hyperthyroidism).
Pulse: Check for tachycardia or Atrial Fibrillation, which is common in thyrotoxicosis.
Face & Eyes
Inspect for “Thyroid Eye Disease” (Graves’ Ophthalmopathy):
Exophthalmos/Proptosis: Forward protrusion of the eyeball (view from above or the side).
Lid Lag: Ask the patient to follow your finger as you move it vertically downward; a delay in the upper eyelid moving down is “lid lag.”
Conjunctival Injection: Redness or swelling (chemosis) of the eyes.
Ask the patient to sit normally and look for:
Goitre: Generalized swelling of the thyroid gland.
Scars: Look for a “collar scar” from a previous thyroidectomy.
Distended Veins: May indicate a retrosternal goitre (Pemberton’s sign).
Dynamic Manoeuvres
Swallow: Give the patient a glass of water and ask them to take a sip. A thyroid mass will move upward during swallowing.
Tongue Protrusion: Ask the patient to stick out their tongue. A thyroglossal cyst will move upward, whereas a thyroid gland mass will not.
Palpation is best performed by standing behind the patient.
The Gland: Place your hands around the patient’s neck with your fingers on the thyroid gland (below the cricoid cartilage). Palpate for size, symmetry, and nodules.
Swallow Again: Ask the patient to take another sip of water while you palpate to feel the gland move under your fingers.
Lymph Nodes: Palpate the cervical lymph node chain (anterior and posterior) for any enlargement.
Trachea: Check for tracheal deviation, which may occur with large goitres.
Percussion: Percuss downward from the sternal notch. Dullness suggests a retrosternal goitre.
Auscultation: Use the diaphragm of your stethoscope to listen for a thyroid bruit over each lobe (indicates increased vascularity in hyperthyroidism).
To finish your OSCE thyroid assessment, state you would:
Test Reflexes: Check the biceps or knee jerk for “delayed relaxation” (hypothyroidism) or “briskness” (hyperthyroidism).
Check for Pretibial Myxoedema: Waxy, discolored induration of the skin on the shins (Graves’ disease).
Proximal Myopathy: Ask the patient to stand up from a chair without using their arms.
Request Thyroid Function Tests (TFTs): Measure TSH, $T_{3}$, and $T_{4}$.
| Feature | Hyperthyroidism (Thyrotoxicosis) | Hypothyroidism (Myxoedema) |
| Metabolism | Weight loss, heat intolerance | Weight gain, cold intolerance |
| Heart Rate | Tachycardia / Atrial Fibrillation | Bradycardia |
| Reflexes | Brisk | Slow-relaxing |
| Skin | Warm, moist, thin | Dry, cold, thickened |
| Mood | Anxiety, restlessness | Low mood, mental slowness |
For a visual guide to the movements and palpation technique:
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