Vitals

• HR (high), AF
• Fever

Thyroid

Inspection

• Neck inspection (front to back)
  • SEADS: swelling, erythema, atrophy, deformity, scars
    • Scars (thyroid surgery: typically located above the suprasternal notch)
    • Base of the neck
  • Masses, lesions (midline)
  • Asymmetry
  • Goitre - front and side*
  • Ask the patient to take 🥤a sip of water, inspect for upward movement of thyroid gland
    • Abnormality in size, contour, and symmetry
    • Won't see normal thyroid tissue

Palpation

• Clinical Skill Version (palpate ipso. to side of head turn)
• ENT version (palpate contra. to side of head turn)

Reporting:

• Palpable or Non-palpable
• Size of the gland—normal or enlarged; if enlarged, diffusely or focal
• Texture
• Presence or absence of tenderness
• Any masses/nodules—single or multiple
• Presence or absence of palpable regional lymph nodes

• Auscultation (if enlarged or sign of hyperthyroidism)
  • Thyroid Bruits (low pitch, use a Bell)
  • Flow Murmur

Lymph Node

• Cervical Lymph Node Exam

Outside of the Neck

Hand

• Tremor ?
• Moist & warm/Cold & dry?
• Onycholysis (rare)