[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Skin, head and neck](https://durgical.com/en/clinical-exam/#a-head_neck) › Thyroid examination [Clinical exam](https://durgical.com/en/clinical-exam/) · [Skin, head and neck](https://durgical.com/en/clinical-exam/#a-head_neck) # 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](https://durgical.com/en/anatomy/thyroid-gland/) · [Thyroid cartilage](https://durgical.com/en/anatomy/thyroid-cartilage/) · [Cricoid cartilage](https://durgical.com/en/anatomy/cricoid-cartilage/) · [Trachea](https://durgical.com/en/anatomy/trachea/) · [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/) · [Hyoid bone](https://durgical.com/en/anatomy/hyoid-bone/) ## Key points - The thyroid rises on swallowing because it is wrapped in pretracheal fascia; a thyroglossal cyst also rises with tongue protrusion. - The isthmus lies below the cricoid, over the second to fourth tracheal rings. - Thyroid bruit = increased blood flow, typical of Graves disease. - Pemberton sign (arms up with facial plethora): retrosternal goitre. - A hard, fixed nodule with nodes or hoarseness is suspicious for cancer. ## 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. ## Memory aid A 'thyroid' that does not rise on swallowing may not be thyroid; what rises with the tongue points to the thyroglossal duct. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/thyroid-examination/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Thyroid gland](https://durgical.com/en/anatomy/thyroid-gland/) - [Thyroid cartilage](https://durgical.com/en/anatomy/thyroid-cartilage/) - [Cricoid cartilage](https://durgical.com/en/anatomy/cricoid-cartilage/) - [Trachea](https://durgical.com/en/anatomy/trachea/) - [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/) - [Hyoid bone](https://durgical.com/en/anatomy/hyoid-bone/) ## Related - [Lymph node examination](https://durgical.com/en/clinical-exam/lymph-node-examination/) - [Hyperthyroidism and hypothyroidism: the signs](https://durgical.com/en/clinical-exam/hyperthyroidism-and-hypothyroidism-the-signs/) - [Eye exam: visual acuity, visual fields and eye movements](https://durgical.com/en/clinical-exam/eye-exam-visual-acuity-visual-fields-and-eye-movements/) - [Diagnostic facies](https://durgical.com/en/clinical-exam/diagnostic-facies/) ## Related conditions - [Thyroid nodule](https://durgical.com/en/conditions/thyroid-nodule/) - [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/) - [Goitre](https://durgical.com/en/conditions/goitre/) - [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/) - [Thyroid cancer (papillary)](https://durgical.com/en/conditions/thyroid-cancer/) - [Thyroiditis (subacute, painless and postpartum)](https://durgical.com/en/conditions/thyroiditis/) [← All of the clinical exam](https://durgical.com/en/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](https://medlineplus.gov/ency/article/001178.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Thyroid nodule: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/007265.htm) (MedlinePlus, U.S. National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/thyroid-examination/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/thyroid-examination/