From the Guidelines
To check and palpate the thyroid for assessment, position the patient sitting upright with their neck slightly extended, and use both hands to gently palpate the thyroid gland, which is located in the anterior neck below the larynx, while the patient swallows, as recommended by recent clinical guidelines 1. When performing the palpation, it is essential to follow a systematic approach to ensure a thorough assessment.
- First, inspect the neck visually for any visible enlargement, asymmetry, or nodules.
- Then, place your thumbs on the back of the patient's neck with your fingers on either side of the trachea where the thyroid is located.
- Ask the patient to swallow, which can be facilitated by offering a sip of water, while you feel the movement of the thyroid gland against your fingers. This technique allows you to assess the size, shape, consistency, and presence of any nodules or tenderness, as well as the symmetry of the thyroid gland, which is crucial for detecting conditions such as goiter, thyroiditis, or thyroid nodules that may indicate underlying thyroid dysfunction, as noted in the acr appropriateness criteria® thyroid disease study 1. It is also important to note that screening for thyroid cancer by palpation is not recommended by the US Preventive Task Force, as stated in the study 1, but if a patient presents with a palpable neck nodule, the goal of imaging is to determine if the palpable abnormality corresponds to a thyroid nodule and to characterize the nodule for malignancy risk.
- The normal thyroid is usually not prominently palpable, and any abnormalities should be further evaluated with thyroid function tests, such as serum thyroid-stimulating hormone (TSH) levels, to determine the underlying cause of the palpable nodule or thyroid enlargement.
From the Research
Checking and Palpating the Thyroid for Assessment
To assess the thyroid, a comprehensive evaluation is necessary, which includes anatomy-based inspection and palpation, imaging, and blood tests 2. The thyroid gland is located in the neck, and approximately half of the lateral part of the thyroid is deep to the sternocleidomastoid (SCM) and sternothyroid muscles, making it difficult to palpate the entire gland using prior physical examination techniques.
Steps for Palpation
The goal of a modified anatomy-based thyroid examination is to minimize the number of structures between the physician's fingers and the patient's thyroid by utilizing:
- Neck flexion
- Side bending
- Rotation This approach allows for a more thorough evaluation of the thyroid gland and may enable earlier detection of thyroid cancer, which is increasingly common in the United States 2.
Importance of Proper Technique
If the thyroid is approached from behind the patient, nodules can be missed due to the muscles and transverse processes overlaying them 2. Therefore, it is essential to use a proper technique to ensure a comprehensive evaluation of the thyroid gland.
Additional Diagnostic Tools
While palpation is an essential part of thyroid assessment, additional diagnostic tools such as ultrasound examination can provide valuable information about the thyroid gland and its abnormalities 3, 4, 5, 6. Ultrasound examination is a rapid and radiation-free method that can help identify thyroid nodules, cysts, and other abnormalities, and guide further management and treatment.