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Techniques: Thryroid Exam
There are several physical examination maneuvers described for examination of the thyroid described below that are at least moderately sensitive and specific. Much of the exam is based on physiological reasoning and tradition rather than on studies of reliability or precision. Combining the examination and association signs and symptoms increases the accuracy of the physical examination of the thyroid.
Goiter: Examination of the thyroid for sizeNote: An enlarged thyroid is referred to as a goiter. There is no direct correlation between size and function- a person with a goiter can be euthyroid, hypo- or hyperthyroid.
A normal thyroid is estimated to be 10 grams with an upper limit of 20 grams or 2 to 4 teaspoons.
Examination for goiter can increase the possibility of thyroid disease in patients with symptoms of hypo- or hyperthyroidism, in determining the choice of treatment in hyperthyroidism and monitoring the response to therapy directed at decreasing the size of the thyroid in cases of symptomatic goiter.
The examination consists of three portions:
InspectionInspection: Anterior Approach
PalpationNote: There is no data comparing palpation using the anterior approach to the posterior approach so examiners should use the approach that they find most comfortable.
Palpation: Anterior Approach
Palpation: Posterior Approach
Synthesis of data from these techniques
Using the data from anterior and lateral inspection and from palpation, categorize the gland as:
Nodules: Examination of the thyroid for nodularity
Thyroid nodules are common (prevalence 4%). Half of the thyroids glands examined by ultrasound or direct visualization (surgery or autopsy) have nodules. Physical examination detects approximately 10% of the nodules found by these methods. Nodules increase in frequency with age and are four times more likely in women than men. Less than 5% of all nodules are cancerous.