Dr. Neil Gesundheit Teaches the Thyroid Exam this Week
January 31, 2014
Thank to our endocrine specialist, Dr. Neil Gesundheit, for leading our Stanford Medicine 25 session this week on the thyroid exam! Read below to learn some tips about the thyroid exam directly from Dr. Gesundheit.
Thyroid exam tips from Dr. Gesundheit:
(1) Position the patient upright, looking straight forward.
(2) Palpate the key neck landmarks no matter how confident you may be that you know where the thyroid gland should be. These landmarks are the superior border of the thyroid cartilage (the “Adam’s apple”), the cricoid ring (about 4-5 cm below that), and the area immediately below the cricoid ring — the thyroid bed.
(3) Use one of 3 techniques — of your choosing — to palpate the thyroid gland. These techniques are (for anterior approaches): after locating the thyroid bed, using two hands, one thumb on each side of the mid-line; or, using one hand, a thumb (on one side) and the index and middle finger (on the other side) of the mid-line. If using a posterior approach, an index finger and middle finger from each hand on each side of the mid-line in the thyroid bed.
(4) Once your fingers are properly positioned in the thyroid bed, ask the patient to swallow. It is often useful to have a patient keep a small sip of water in his/her mouth to help with the swallowing motion.
(5) If a goiter or thyroid nodule is unilateral, it is often good to palpate the area with the patient’s head turned. The patient should turn his/her head to the right to allow a better examination of the left lobe of the thyroid; the patient should turn his/her head to the left to allow a better examination of the right lobe of the thyroid.
(6) In cases of significant goiter, it is useful to listen over the thyroid gland to ascertain if a bruit is present.