Clinical Evaluation for Thyroid Disease

Doctor examining woman's thyroid
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Diagnosing thyroid disease is a process that should incorporate a number of key steps, including a thorough clinical evaluation, various blood tests, imaging tests, biopsies and pathological evaluation, genetic tests, and other relevant tests and evaluations of your thyroid function. Here, the thyroid-specific aspects of a clinical examination for thyroid disease are explored more fully so you know what you should expect from a thyroid evaluation with your health care practitioner.

A critical part of detecting and diagnosing thyroid disease is an in-person clinical evaluation conducted by a trained health care practitioner. As part of a thorough clinical thyroid evaluation, your practitioner typically perform the following examinations and evaluations.

Feel (also known as “palpating”) your neck.

Your practitioner should feel your neck, looking for any thyroid enlargement (goiter), lumps, nodules and masses in the area around your thyroid. This process is referred to as "palpating" the thyroid. Some trained practitioners are also looking for something known as "thrill" on palpation. Thrill is when the practitioner can feel the sensation of increased blood flow in your thyroid.

Listen to your thyroid using a stethoscope.

Your practitioner should listen to your thyroid area, to detect what’s known as "bruit." Bruit means that when she or he is listening with a stethoscope, the practitioner can hear the sound of increased blood flow in the thyroid.

Test your reflexes.

Reflexes are affected by thyroid function. Your health care provider should test your reflexes with a small mallet, tapping your knees and Achilles area. Hyper-responsive reflexes can be a sign of hyperthyroidism, and slow reflexes may point to hypothyroidism.

Check your heart rate, rhythm and blood pressure.

Your practitioner should check your heart rate, rhythm, and do a blood pressure check. A slow heart rate (bradycardia) may point to hypothyroidism, and a high heart rate (tachycardia) may point to hyperthyroidism. Some patients with hypothyroidism have heart palpitations or mitral valve prolapse. And people with hyperthyroidism are more likely to have rhythm irregularities like atrial fibrillation. Low blood pressure can be associated with hyperthyroidism, while high blood pressure is more common in hyperthyroidism.

Measure your weight.

You should get on the scale to get a current weight. Rapid weight gain without a change to diet or exercise, as well as inability to lose weight despite diet and exercise, are possible signs of hypothyroidism. Weight loss without a change to diet or exercise, or even when eating more, may point to hyperthyroidism.

Measure your body temperature.

Your health care provider should take your body temperature. Low body temperature is considered by some practitioners as a possible sign of an underactive thyroid.

Examine your face.

A careful examination of your face is an essential part of the exam. Your practitioner is looking for loss of hair in the outer edge of the eyebrows, a common symptom of hypothyroidism, as well as puffiness or swelling of the eyelids or face, another common hypothyroidism symptom.

Examine your eyes.

The eyes are often affected in thyroid patients, and common clinical symptoms include: bulging or protrusion of the eyes; a stare in the eyes; retraction of upper eyelids; a wide-eyed look; infrequent blinking. You may also have something called “lid lag," when your upper eyelid doesn't smoothly follow downward movements of the eyes when you look down.

Observe the general quantity and quality of your hair.

Hair loss is seen in both overactive and underactive thyroid. Coarse, brittle or strawlike hair can point to hypothyroidism. Thinning, finer hair may point to hyperthyroidism.

Examine your skin.

Thyroid disease, especially hyperthyroidism, can show up in a variety of skin-related symptoms that can be clinically observed. These include a yellowish, jaundiced cast to the skin; unusually smooth, young-looking skin; hives; lesions or patches of rough skin on the shins (known as pretibial myxedema or Graves’ dermopathy); or blister-like bumps on the forehead and face (known as milaria bumps).

Examine your nails and hands.

Your practitioner should look for hyperthyroidism-related clinical signs in your nails and hands, including:

  • Onycholysis, a separation of the nail from the underlying nail bed, also called Plummer's nails
  • Swollen fingertips, also called acropachy

Review other clinical signs.

Your practitioner should assess other clinical signs of hyperthyroidism, including:

  • Tremors
  • Shaky hands
  • Hyperkinetic movements -- table drumming, tapping feet, jerky movements
  • Low bone density, seen via DEXA scan or x-ray

Your practitioner should evaluate other clinical signs of hypothyroidism, including:

  • A dull facial expression
  • Slow movement
  • Slow speech
  • Hoarseness of voice
  • Edema (swelling) of the hands and/or feet
View Article Sources
  • Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2012.