Introduction: Introduce yourself and explain what you will be doing.

1) Vitals: Ask for vital signs.

2) General:

• Eyes: Look for Periorbital myxedema, Exophthalmos, Lid lag, 1/3 eyebrows loss,

• Hands: Fine tremors, Sweaty palms & palmar erythema, Nail changes, Hair loss

• Muscle wasting: shrug shoulder against resistance

• Knee reflex

• Legs: Pretibial  myxedema

2) Inspection:

• Look for Swelling/goitre, scars, sinuses, dilated vessels

• Swallow test

• Tongue protrusion

3) Palpation:

• From behind: Size, consistency, Temperature, borders and mobility (also while swallowing)

• H&N LNs (especially submandibular and Cervical LNs)

4) Percussion:

• Percuss over the sternum for retrosternal goitre (no retrosternal dullness)

5) Ausculation: both lobes for thyroid bruits

6) Special tests:

• Pemberton sign: Raising both arms above head causes facial flushing, dilated H&N veins and inc JVP (thoracic inlet obstruction from goitre)