Examination of the thyroid

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1. Wash hands
2. Introduce yourself to the patient and thank them
3. Position patient adequately
4. Expose patient's chest by removing the hospital gown
5. Place pillow underneath hands
6. Examine nails
7. Test for fine tremor by asking patient to bring hands up and then place a sheet of paper suspended on their hands
8. Ask patient to turn hands over
9. Palpate palms for diaphoresis and examine for palmar erythema
10. Take pulse
11. Note rhythm of pulse
12. Test reflexes
13. Check blood pressure
14. Check for proximal myopathy
15. Perform Pemberton's sign whilst looking into eyes and examining tongue
16. Inspect eyes for lid retraction and from side for exopthalmos
17. Check for chemosis of conjunctiva
18. Check visual fields by confrontation
19. Check for lid lag using the red hat pin
20. Check for diplopia
21. Observe neck from front
22. Ask patient to swallow a sip of water and examine neck mass
23. Palpate thyroid gland from behind
24. Assess cervical, supraclavicular, tonsillar, submandibular lymphadenopathy
25. Palpate from the front for a throid bruit
26. Palpate for carotid pulse
27. Auscultate for a thyroid bruit
28. Check for tracheal deviation
29. Percuss underneath the sternum for retrosternal extension
30. Palpate and test strength of steromastoid muscles as malignant disease may infiltrate this muscle
31. Percuss for pleural effusion
32. Auscultate for pleural effusion
33. Palpate legs for pretibial myxoedema
34. Assess ankle reflexes
35. If there is time assess for signs of heart failure
    1. JVP
    2. Note sand paper dry, rough skin of hypothyroidism
    3. apex beat
    4. auscultation​