How to describe a goiter on physical examination?

From the Guidelines

When describing a goiter on physical examination, focus on its size, consistency, symmetry, tenderness, and associated findings, as these elements are crucial in determining the etiology and guiding management, as suggested by recent guidelines 1. To describe a goiter on physical examination, begin by inspecting the neck for visible enlargement or asymmetry, then palpate the thyroid gland with the patient's neck slightly extended.

• Note the size using WHO classification (0-3, with 0 being no goiter and 3 being visible from a distance) or by measuring in centimeters.
• Document whether the enlargement is diffuse or nodular, symmetric or asymmetric, and describe the consistency (soft, firm, or hard).
• Check if the goiter moves with swallowing, which is characteristic of thyroid tissue.
• Assess for tenderness, which may suggest inflammation.
• Auscultate for bruits, which can indicate increased vascularity in hyperthyroidism. Also, note any associated findings such as cervical lymphadenopathy, exophthalmos, or tremor that might suggest underlying thyroid dysfunction, as highlighted in the ACR Appropriateness Criteria for thyroid disease 1. A complete description should include these elements to provide a comprehensive assessment of the goiter and help determine its etiology, whether it's due to iodine deficiency, autoimmune disease, inflammation, or neoplasm, and guide further imaging and management, with ultrasound being the preferred first-line imaging modality for suspected goiter 1.

From the Research

Describing Goiter on Physical Examination

To describe goiter on physical examination, consider the following points:

• Goiter refers to an enlarged thyroid gland, which can be caused by various factors such as autoimmune disease, thyroid nodules, or iodine deficiency 2
• Patients with goiter may be asymptomatic or present with compressive symptoms like cough or dysphagia 2
• On physical examination, the thyroid gland should be assessed for size, shape, and consistency
• The presence of nodules or tenderness should also be noted

Key Findings on Physical Examination

Some key findings to look for on physical examination include:

• Enlargement of the thyroid gland, which can be diffuse or nodular
• Presence of compressive symptoms such as cough or dysphagia
• Thyroid bruit or tenderness, which can indicate inflammation or infection
• Assessment of the patient's overall thyroid function, including signs of hypothyroidism or hyperthyroidism 2

Diagnostic Evaluation

After physical examination, further diagnostic evaluation may be necessary, including:

• Thyroid stimulating hormone (TSH) test to assess thyroid function 2
• Thyroid ultrasound to evaluate the size and structure of the thyroid gland and to guide biopsy if necessary 2
• Radionuclide scan to assess thyroid function and identify any areas of abnormal uptake 2