Thyroid nodule physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Physical examination should focus on the thyroid gland and the lateral and central neck and should assess for supraclavicular and submandibular adenopathy.

Physical Examination

a rapid pulse rate may suggest hyperthyroidism, and hypertension may occur in the context of multiple endocrine neoplasia, type II (MEN II)

HEENT

• Thyroid nodule
  • Solitary or dominant in a multinodular goiter
  • Characteristics of the nodule, including:
    • Size
    • Consistency (e.g., soft, firm, woody, or hard)
      • Nodules that are firm or immobile are more likely to harbor cancer than those that are soft or mobile
      • Large, firm cervical nodes ipsilateral to the thyroid nodule should suggest the possibility of local metastases from thyroid cancer
      • firm to hard, irregular, fixed, nontender nodule is more likely to be a thyroid malignant neoplasm
      • A smooth, soft, easily mobile nodule suggests benignancy, as does the presence of tenderness
      • some benign nodules can be very hard because of calcifications
      • Multinodularity, especially if the nodules all have the same con¬ sistency, is consistent with a be¬ nign multinodular goiter. A nodule or mass that is dominant in size or has a different consistency than other nodules within the gland should be evaluated for malignancy more precisely
      • A midline nodule over the hyoid bone that moves up with protrusion of the tongue is likely to be a thyroglossal duct cyst.
    • Involvement with adjacent structures
• Cervical lymph nodes, including:
  • submental and submandibular nodes
  • upper jugular nodes
  • midjugular nodes
  • lower jugular nodes
  • posterior triangle and supraclavicular nodes
  • pretracheal, prelaryngeal, and paratracheal nodes
• Deviation of the trachea, which suggests a mass

follicular adenoma or carcinoma	compressive symptoms such as dyspnea, coughing, choking sensation, dysphagia, inability to lie flat, or hoarseness	hyperthyroidism 1% of follicular adenomas are toxic adenomas, causing symptomatic hyperthyroidism