Feeling of the thyroid gland is carried out after examination, sometimes both methods are used simultaneously. There are many techniques for palpation of the thyroid gland, it can be felt with one or two hands at the same time, in the position of the doctor in front of the patient and behind him. The choice of study depends on the structure of the neck, the nature of the changes in the gland, but more on the habits and experience of the doctor.
Palpation of the thyroid gland is carried out in stages – first superficial, then deep (special). Palpation of the thyroid gland in the position of the doctor in front of the patient.
The study is carried out in the patient’s position, standing alone and during swallowing (the patient is asked: “Swallow saliva, please”), when the thyroid gland, rising with the larynx, slides under the fingers of a doctor, which makes it possible to evaluate its quality.
First, superficial (approximate) palpation is performed . The doctor’s left hand is placed behind the patient’s neck to fix the body and head. This is necessary, since during the study, many of them experience unpleasant sensations from manipulations on the neck and subconsciously move back from the doctor.
The doctor’s right hand is placed on the area of the thyroid gland – from the middle of the thyroid cartilage down, and with a sliding motion it feels the front surface of the neck to the jugular notch. If the patient’s neck is long, then the fingers are mounted vertically, with the final phalanges up. With a short neck, high standing of the chest, fingers can be positioned horizontally.
Superficial feeling allows you to determine: • skin temperature above the gland; • approximate size of the gland, its shares; • the nature of the surface of the gland; • organ density: • the presence of large nodes; • the presence of vascular pulsation and trembling; • soreness of the gland.
In a healthy person, with superficial palpation of the thyroid gland location, the skin temperature does not differ from the skin temperature of other parts of the body, the thyroid gland is not palpable, pulsation above the gland, trembling are not detected, there is no pain.
A local increase in skin temperature is noted in the acute inflammatory process of the thyroid gland – thyroiditis, abscess, tuberculosis. The enlargement of the gland is detected only with its large size, sometimes only one lobe or isthmus is palpated, and large nodes located closer to the surface of the gland (nodular goiter, tumor, cyst) are easily detected.
Superficial palpation reveals only a significant (ligneous) density of the enlarged gland, which is typical for a tumor of the gland of some forms of chronic thyroiditis. Vascular pulsation and trembling (“cat purr”) are detected with severe diffuse toxic goiter. Soreness of the gland occurs with its inflammatory lesion – acute thyroiditis, abscess, tuberculosis, trauma, hemorrhage. More complete information is provided by special (deep) palpation of the thyroid gland.