(1) Thyroid cartilage; (2) Cricoid cartilage; (3) thyroid isthmus

from top to bottom.

Since physical characteristics of a nodule have little diagnostic value, the ability to incorporate radioactive iodine should be determined to its true nature (benign or malignant)

Hot nodules: nodules that concenctrate radioactive iodine => benign (<1%)

Cold nodules: nodules that fail to concentrate iodine => malignant (10-20%)

Hyperthyroidism - thyrotoxicosis due to thyroid over activity

Common symptoms: heat intolerance, nerouvsness, anxiety, excessive sweating, palpitations, diarrhea, amenorrhea, weight loss, and low grade fever.

Signs: lid retraction, lid lag, fine finger tremor, moist warm skin, and HR > 90 BPM

If secondary to Graves' disease: exophthalmos, vitilgo, fingernail clubbing, and pretibial myxedema

Hypothyroidism - abnormally low levels of free thyroid hormone in the plasma

Symptoms: cold intolerance, lethargy, mental dullness, constipation, menorrhagia, loss of libido, weight gain, hoarseness, and loss of sweating.

Signs: coarse, cool, and dry skin; slow, deep and nasal speech, HR < 70 BPM; perioribtal puffiness, goiter.

Exam technique:

Wash hands.

Inspect neck and identify landmarks-thyroid cartilage, cricord cartilage, isthmus.

Palpate thyroid without swallowing.

Palpate thyroid with swallowing.

Palpate thyroid from front of patient.

Palpate thyroid in correct anatomical location.

Auscultate for thyroid bruit if enlarged.