Thyroid examination !

Exam technique

How the thyroid is looked at and felt in the neck, why the patient is asked to swallow, and which findings suggest goitre or a nodule.

Updated 2026-11-01

See it in 3D: Thyroid gland · Thyroid cartilage · Cricoid cartilage · Trachea · Sternocleidomastoid · Hyoid bone

What it is

The thyroid exam looks for diffuse enlargement (goitre), nodules and signs of compression, together with signs of hyper- or hypothyroidism. The gland is wrapped in pretracheal fascia and rises on swallowing, which helps tell it apart from other neck masses. Palpation is insensitive for small nodules; ultrasound complements it.

Landmark anatomy

The thyroid has two lobes joined by an isthmus that crosses in front of the second to fourth tracheal rings, below the cricoid.
It is wrapped in pretracheal fascia attached to the larynx: that is why it rises on swallowing.
Sternocleidomastoid partly covers the lobes; relaxing it with slight neck flexion makes palpation easier.
The recurrent laryngeal nerves run behind the gland: hoarseness with a nodule raises concern for invasion.

Technique, step by step

Seat the patient with the neck slightly extended and tangential light; inspect from the front and in profile.
Ask the patient to take a sip of water and swallow: watch whether a mass rises with swallowing.
Find the landmarks: thyroid cartilage, cricoid cartilage and, below it, the isthmus over the upper tracheal rings.
Posterior approach: stand behind the patient with the fingers of both hands below the cricoid, the neck slightly flexed.
Feel the isthmus while the patient swallows; then gently displace the trachea to one side to feel the opposite lobe.
For each lobe describe size, consistency (soft, firm, hard), surface (smooth, nodular), tenderness and movement on swallowing.
If there is a nodule, measure it and ask the patient to stick out the tongue: a thyroglossal cyst rises with tongue protrusion.
Auscultate each lobe with the bell: a continuous bruit suggests increased blood flow, as in Graves disease.
Check for tracheal deviation and ask the patient to raise both arms for a minute: facial plethora or dizziness suggests a retrosternal goitre (Pemberton sign).
Feel the cervical nodes and look for signs of thyroid function: tremor, skin, pulse, reflexes and eye signs.

Abnormal findings

Diffuse goitre: iodine deficiency (still relevant in Andean areas), Graves disease, Hashimoto thyroiditis.
Diffuse goitre with a bruit, exophthalmos and signs of hyperthyroidism: Graves disease.
Suspicious nodule: hard, fixed to nearby structures, with cervical nodes, hoarseness, rapid growth, prior neck radiation, age under 20 or over 70, male sex.
A tender thyroid after a respiratory infection: subacute thyroiditis.
Dysphagia for solids, breathlessness lying flat or hoarseness suggest compression by a large goitre.

Common errors

Feeling too high, over the thyroid cartilage, instead of below the cricoid.
Not asking the patient to swallow: without the rise on swallowing the gland is hard to identify.
Trusting a normal exam: palpation misses many small nodules; ultrasound is the test of choice.
Forgetting the cervical node exam and the thyroid function signs.

Test yourself

Think of the answer, then tap the question to see it.

Why does the thyroid rise on swallowing?

Because it is wrapped in pretracheal fascia attached to the larynx, which rises during swallowing.

Which midline neck mass rises when the tongue is stuck out?

A thyroglossal duct cyst, attached to the hyoid bone and the base of the tongue.

What does a bruit over the thyroid mean?

Increased blood flow through the gland, typical of Graves disease.

What does the Pemberton sign test for?

A goitre extending behind the sternum: raising the arms narrows the thoracic inlet and causes facial plethora, dizziness or breathlessness.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Simple goiter: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Thyroid nodule: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026).

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Representative model, for educational purposes only.