Examinations
CPSA · Clinical examination · Endocrine
Thyroid status & neck examination
Assess the neck lump (inspect → palpate → percuss → auscultate → swallow/tongue) AND the thyroid status (signs of hyper- or hypothyroidism), then state your clinical impression.
Practise it out loudPosition: Patient seated, neck exposed; a glass of water for swallowing.
The routine
Neck lump
- 1Inspect from the front; ask to swallow (thyroid moves up) and protrude the tongue (thyroglossal cyst moves up)
- 2Palpate from behind: size, consistency, nodularity, tenderness; assess tracheal deviation and lymph nodes
- 3Percuss for retrosternal extension; auscultate for a bruit (Graves’)
Thyroid status — hands & face
- 1Hands: fine tremor, sweating, warm/cool, palmar erythema, thyroid acropachy, pulse (AF/tachy vs brady)
- 2Eyes: exophthalmos, lid lag, lid retraction, ophthalmoplegia (Graves’)
- 3Face: hair, skin (dry/coarse), expression
Reflexes & legs
- 1Reflexes: brisk (hyper) vs slow-relaxing (hypo)
- 2Pretibial myxoedema (Graves’), proximal myopathy
Signs & what they mean
Diffuse goitre + bruit + exophthalmos + pretibial myxoedemaGraves’ disease
Single firm nodule that moves on swallowingThyroid nodule (needs USS ± FNA)
Midline lump that moves up on tongue protrusionThyroglossal cyst
Bradycardia, slow-relaxing reflexes, dry skin, coarse featuresHypothyroidism
Tremor, warm sweaty palms, AF, lid lagHyperthyroidism
To complete, I would…
- Request thyroid function tests (TSH, free T4) and thyroid autoantibodies
- Ultrasound the neck ± fine-needle aspiration for a nodule
- ECG if arrhythmia suspected
OSCE tips
- Palpate the thyroid from behind; always ask the patient to swallow.
- Swallowing moves a thyroid lump; tongue protrusion moves a thyroglossal cyst.
- Comment on thyroid *status* (clinically eu-/hyper-/hypothyroid), not just the lump.