The palpation of the thyroid is a simple and painless examination which makes it possible to diagnose an anomaly of the thyroid. Where, when and how to do it? What signs suggest a normal or abnormal thyroid? Insights from Dr Olivier Dupuy, Head of the Endocrinology, Diabetes and Nutrition Department at Paris Saint-Joseph Hospital.
When to do a thyroid palpation?
Thyroid palpation is part of the general examination, but it is particularly indicated in the presence of signs of dysthyroidismi.e. signs leading to the suspicion abnormal functioning of the thyroid. The two main thyroid conditions are hyperthyroidism, which is responsible for hyperthermia, perspiration, hot flushes, abnormal fatigability, tachycardia, mental and physical hyperactivity. “These varied symptoms may be associated with a proptosis, which is characterized by the protrusion of the eye in front of the orbit. Palpation of the thyroid often shows a large goiter, sometimes visible to the naked eye. This is usually vascular, that is to say that one can perceive a small tremor (thrill) which corresponds to an acceleration of the arterial blood speed“, specifies Dr. Olivier Dupuy. And hypothyroidism which results in a general metabolic slowdown, causing fatigue, difficulty concentrating, memory problems, nervousness or even bradycardia. On palpation, the thyroid may be enlarged or, on the contrary, difficult to detect. Suspicion of dysthyroidism must be confirmed by measuring thyroid hormones and their regulator, TSH.
Where to do a thyroid palpation?
Palpation of the thyroid is a screening test which is part of the general clinical examination. It is carried out by the attending physician.
“Self-examination is not recommended because it is complicated”
What is the technique?
“The doctor stands behind the patient who is seated. Then, he places his hands at the base of the neck, at the height of the sternal manubrium (upper part of the sternum), and the patient is asked to swallow because the swallowing will cause the thyroid to rise. On the other hand, self-examination is not recommended because it is complicated“, indicates the Head of the endocrinology, diabetology and nutrition department of the Paris Saint-Joseph hospital.
Normal thyroid: what signs on palpation?
The palpation of the thyroid is considered normal when it does not present no nodules or increase in volume.
Abnormal thyroid: what signs on palpation?
The palpation of the thyroid is described as abnormal in the presence of nodules or global enlargement of the thyroid. We then speak of goitre.
What does a painful thyroid on palpation mean?
“Pain on palpation is very infrequent because the thyroid is an organ which, in general, is not expressed by pain. It is seen specifically in Quervain’s thyroiditis, a very localized inflammation of the thyroid which is manifested by elective pain suggesting angina“, informs the specialist. This very precise pain at the anterior cervical level is generally accompanied by an alteration of the general state. The pain can also come from a very rapidly growing cyst which leads to compression but this time the diagnosis is obvious.
What to do in case of abnormal palpation of the thyroid?
In the presence of an anomaly of the thyroid (nodules or homogeneous goitre), the palpation will be supplemented by a thyroid ultrasound. The latter offers criteria for classifying nodules according to the international classification called TIRADS. Stage 2 and 3 nodules have no criteria for malignancy; stage 4 nodules are associated with a suspicion of malignancy and stage 5 nodules with a very strong suspicion. “TIRADS 4 and 5 nodules are an indication to be performed a cytopuncture, which consists of aspirating cells from a suspicious nodule, then placing the sample on a slide to determine if the nodule is benign or if it shows signs of malignancy, a signature of cancer”, develops Dr. Olivier Dupuy.
Thanks to Dr Olivier Dupuy, Head of Endocrinology, Diabetology and Nutrition at Paris Saint-Joseph Hospital.