Thyroid Self Exam: Where is the thyroid Gland?
Are You Feeling for Your Thyroid Gland in the Wrong Place?
Too often when people are feeling for the thyroid, their fingers are nowhere near the thyroid gland. The thyroid cartilage, despite its name, is not where the gland is situated. Even physicians don’t even feel for the thyroid but just get thyroid blood tests. This is a bad idea because thyroid feel is a critical part of the evaluation of a patient with possible thyroid disease.
First of all look at your neck in the mirror. Swallow. The patient seen here was noted to have a nodule in her left thyroid lobe just by visual inspection alone.
After looking now you can feel your neck.
Do this on yourself or someone:
- Put your finger on tip of your chin (mentalis).
- Slide finger down the midline and the first hard structure you hit is the top of the thyroid cartilage. (Surprisingly, one does not feel the hyoid bone in the midline, although sometimes its lateral end is misidentified as a hard lymph node).
- Run your finger down the prow or the free edge of the thyroid cartilage (Adam’s apple).
- The next thing you hit is the cricoid cartilage (and see if you can get your fingernail in between the thyroid and cricoid cartilage–that is the cricothyroid membrane which is where trans-tracheal aspirations for pneumonia can be performed).
- Below the cricoid ring are the first two rings of the trachea, and the ISTHMUS of the thyroid overlies those two rings.
- Ask patient to flex neck slightly forward and relax.
- Go through the landmarks as above.
- Place first two digits of both hands just below cricoid cartilage so that left and right fingers meet on the patient’s midline. Place thumbs posterior to patient’s neck and flatten all fingers against the neck.
- Use finger pads, not tips, to palpate.
- Identify the isthmus.
- Gently draw fingers laterally 1-2cm.
- Gently palpate lateral lobes.
- NOW ask patient to swallow (give them a glass of water if possible).
- Assess for asymmetrical elevation of lobes (suggests nodularity).
- When you are done with above, move to next phase, which is displacing the soft tissues on one side to the midline while assessing for size with the other hand. Repeat in opposite direction.
- The best position to palpate the thyroid is supine with neck extended from the head of the exam table. Most physicians are too rushed and only feel the thyroid if they even do try sitting. The thyroid moves down into the chest sitting and in short neck individuals.
- Most normal thyroid glands are too small to feel. If you feel a firm thyroid it is not normal.Get TSH, and thyroid antibodies as it is a Hashimoto’s thyroiditis.