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Thyroid status examination

Thyroid status examination and questions for medical student exams, finals, OSCEs and MRCP PACES



  • Wash your hands
  • Introduce yourself
  • Identity of patient – confirm
  • Permission (consent and explain examination)
  • Pain?
  • Position sitting in chair with room behind the chair for the examiner to stand
  • Privacy
  • Expose neck and clavicles (patient may need to tie hair back/ remove necklace)


General Inspection

  • Surroundings
    • Monitoring, walking aids
  • Patient
    • Well or unwell?
    • Hyperthyroid
      • Heat intolerant, flushed, sweaty, fidgety, thin
    • Hypothyroid
      • Cold intolerant, lethargic, hoarse voice, overweight


Systemic examination

  • Hands
    • Inspect
      • Palmar erythema (hyperthyroid)
      • Thyroid acropachy
        • Clubbing and digit swelling in Graves’ disease
    • Palpate
      • Temperature
        • Hot and clammy if hyperthyroid
        • Cold if hypothyroid
      • Pulse
        • Tachycardia or atrial fibrillation (hyperthyroid)
      • Tremor
        • Best seen by resting a piece of paper on patient’s outstretched hands
        • Fine tremor (hyperthyroid)
  • Face
    • Hypothyroid:
      • Coarse facies
      • Thin hair.
        • Loss of the lateral third of the eyebrows (Hertoghe’s sign) is highly variable
  • Eyes
    • Inspection
      • Chemosis (conjunctival oedema)
      • Exopthalmos (Graves’ Disease)
        • Warn the patient you will go behind them. From behind, look down to see if the patient’s eyes protrude
      • Test eye movements
        • Complex ophthalmoplegia (diplopia not consistent with one cranial nerve palsy)
        • Lid retraction
          • Upper lid is retracted upwards and lower lid is retracted downwards
        • Lid lag
          • Sclera can be seen between iris and upper eyelid when patient looks down due to delay in eyelid movement
      • Relative afferent pupillary defect (RAPD – hyperthyroid)
  •  Trunk
    • Proximal myopathy (hyper/hypothyroid)
      • Ask patient to cross arms and stand up from chair
  •  Legs
    • Pretibial myxoedema (Graves’ Disease)
    •  Reflexes
      • Brisk (hyperthyroid)
      • Slow-relaxing (hypothyroid)



  • Thank patient
  • Patient comfortable?
  • Help getting dressed?
  • Wash hands
  • Turn to examiner, hands behind back, holding stethoscope (try not to fidget!) before saying: “To complete my examination, I would like to…”
    • Take a full history
    • ECG
    • Urine dipstick
  •  Ask to look for associated features:
    • T2DM
    • Addisons disease
    • Pernicious anaemia
    • Vitiligo
    • Rheumatoid arthritis
    • SLE


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Common Thyroid status examination exam questions for medical students, finals, OSCEs and MRCP PACES


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