Thyroid Disease: The Clinical Evaluation

Issue #17 July 30, 2012
Welcome to today’s issue of KnowYourThyroid.
Today we have an article from Mary Shomon.
She explains the procedures used for the diagnosis of  thyroid disease. As you will see, it is not a one step and you are done checkup.
Diagnosing thyroid disease is a process that can incorporate numerous factors, including clinical evaluation, blood tests, imaging tests, biopsies, and other tests. Here, the thyroid-specific aspects of a clinical examination for thyroid disease are explored.
A critical part of detecting and diagnosing thyroid disease is a clinical evaluation conducted by a trained practitioner. As part of a thorough clinical evaluation, your practitioner typically should do the following:

Feel (also known as “palpating”) your neck.

Your practitioner is looking for thyroid enlargement (goiter), lumps, nodules and masses in the area around your thyroid. Some trained practitioners are also looking for something known as “thrill” on palpation, this is when the practitioner can “feel” increased blood flow in the thyroid.

Listen to your thyroid using a stethoscope.

The practitioner is listening for what’s known as “bruit,” which means that when she or he is listening with a stethoscope, the practitioner can hear the sound of increased blood flow in the thyroid.

Test your reflexes.

This is usually done with a small mallet on the knees and Achilles area. Hyper-responsive reflexes can be a sign of hyperthyroidism, and slow reflexes may point to hypothyroidism.

Check your heart rate, rhythm and blood pressure.

A slow heart rate (bradycardia) may point to hypothyroidism, and a high heart rate (tachycardia) may point to hyperthyroidism. Some patients with hyperthyroidism also have elevated blood pressure, or rhythm irregularities like palpitations or atrial fibrillation.

Measure your weight.

Rapid weight gain without a change to diet or exercise can be a sign of hypothyroidism, and rapid weight loss may point to hyperthyroidism.

Measure body temperature.

Low body temperature is considered by some practitioners as a possible sign of an underactive thyroid.

Examine your face.

The practitioner is looking for loss of hair in the outer edge of the eyebrows — a symptom of hypothyroidism — as well as puffiness or swelling in the eyelids or face, another common hypothyroidism symptom.

Examine your eyes.

The eyes are often affected in thyroid patients, and common clinical symptoms include: bulging or protrusion of the eyes; a stare in the eyes; retraction of upper eyelids; a wide-eyed look; infrequent blinking; and “lid lag” — when the upper eyelid doesn’t smoothly follow downward movements of the eyes when you look down.

Observe the general quantity and quality of your hair.

Hair loss is seen in both overactive and underactive thyroid. Coarse, brittle or strawlike hair can point to hypothyroidism. Thinning, finer hair may point to hyperthyroidism.

Examine your skin.

Thyroid disease, especially hyperthyroidism, can show up in a variety of skin-related symptoms that can be clinically observed. These include a yellowish, jaundiced cast to the skin; unusually smooth, young-looking skin; hives; lesions or patches of rough skin on the shins (known as pretibial myxedema or Graves’ dermopathy); or blister-like bumps of the forehead and face (known as milaria bumps).

Examine your nails and hands.

Your practitioner should look for hyperthyroidism-related clinical signs in your nails and hands, including:

  • Onycholysis — separation of the nail from the underlying nail bed, also called Plummer’s nails
  • Swollen fingertips, also called acropachy

Review Other Clinical Signs

Your practitioner should assess other clinical signs of hyperthyroidism, including:

  • Tremors
  • Shaky hands
  • Hyperkinetic movements — table drumming, tapping feet, jerky movements
  • Low bone density, seen via DEXA scan or x-ray

Your practitioner should evaluate other clinical signs of hypothyroidism, including:

  • A dull facial expression
  • Slow movement
  • Slow speech
  • Hoarseness of voice
  • Edema (swelling) of the hands and/or feet


Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text. 9th ed., Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.

Mary Shomon,’s Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including “The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age,” “The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss,” “Living Well With Hypothyroidism: What Your Doctor Doesn’t Tell You…That You Need to Know,” “Living Well With Graves’ Disease and Hyperthyroidism,” “Living Well With Autoimmune Disease,” and “Living Well With Chronic Fatigue Syndrome and Fibromyalgia.” Click here  for more information on Mary Shomon.

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