Inspection of the Thyroid Gland – Part 1 of the Physical Examination

Inspection

Inspection means looking at the neck for unusual bulge at the area where the thyroid is usually located, that is, at the central neck.  This unusual bulge may suggest the presence of a thyroid disorder.

One can look at the neck from the front at least and if needed, an additional view from the side.  However, since palpation will be done right away after inspection and palpation is more reliable than inspection to check if there is really an unusual bulge that may suggest the presence of a thyroid disorder, the additional view of inspection may be omitted.

While looking, the physician asks the patient to swallow.  If there is an unusual bulge seen and it moves up and down with swallowing, a thyroid disorder or goiter (a medical term which is defined as any form of thyroid disorder) should be suspected to be present.  If there is an unusual bulge, with continued looking or inspection, one tries to determine whether the bulge is diffuse or nodular.  Diffuse means there is almost symmetrical and smooth enlargement of the two lateral lobes of the thyroid gland (or of the central neck) without any evident nodularity or un-smoothness seen on the skin surface.  Nodular means there is an evident nodularity or un-smoothness seen on the skin surface of the central neck.  There could be one evident nodule or several nodules.

Pictures – no unusual bulge; presence of unusual bulge – diffuse or nodular

(Note: for the moment – 18feb9, will use pictures gotten from Internet.  In the future, will replace them with my own collection of pictures of goiter.)

NO UNUSUAL BULGE

image1

UNUSUAL BULGE – DIFFUSE

images-12

UNUSUAL BULGE – DIFFUSE

imge3

UNUSUAL BULGE – NODULAR – ONE NODULE ON THE RIGHT SIDE 

image 4

UNUSUAL BULGE – NODULAR – MULTIPLE NODULES ON THE RIGHT AND LEFT SIDE OF CENTRAL NECK

goiter

UNUSUAL BULGE – NODULAR – MULTIPLE NODULES ON THE RIGHT AND LEFT SIDE OF CENTRAL NECK

unnamed

At the end of inspection, there must be an initial assessment whether there is an unusual bulge suggestive of a thyroid disorder or goiter, and if there is, whether it is diffuse or nodular.  This assessment should be validated by palpation, which should immediately be done after inspection. 

See also the following:

Minimum Tools in Physical Examination and Physical Diagnosis of the Thyroid Gland

Inspection of the Thyroid Gland – Part 1 of the Physical Examination

Palpation of the Thyroid Gland – Part 2 of the Physical Examination

Physical Examination, Physical Diagnosis and Clinical Diagnosis of Thyroid Disorder – Part 3 of Physical Examination


ROJ-TPOR@18feb9

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