Examine the patient from behind. Start by locating the upper edge of the thyroid cartilage and then move fingers down until the cricoid cartilage is discovered. The isthmus of the thyroid gland can be palpated below the cricoid cartilage and the lobes of the thyroid can be palpated moving laterally from the isthmus. Enlarged size suggests a goiter and presence of multiple assymetric nodules suggest a multinodular goiter. After initial examination, ask the patient to swallow and evaluate the isthmus and lobes during the swallowing. Obvious abnormalities felt on exam or assymetric elevation during swallowing may suggest a thyroid mass.
Lymph Nodes to Note on Exam
Cervical (Superficial, Posterior, and Deep)
Supraclavicular – Virchow’s node (malignant until proven otherwise; abdominal if left SC node and thoracic if right SC node)