Thyroid examination answers two separate questions: what is the lump, and what is the thyroid status. Inspect the neck with the patient swallowing water and protruding the tongue, palpate both lobes and the cervical nodes from behind, percuss the sternum and auscultate, then assess for hyper and hypothyroidism.

Key takeaways

  • A thyroid swelling moves up on swallowing, because the gland is attached to the larynx by the pretracheal fascia.
  • A thyroglossal cyst also moves up on protruding the tongue, because of its tract to the foramen caecum.
  • Percuss down the sternum for the dullness of retrosternal extension.
  • A bruit over the gland suggests the increased vascularity of Graves' disease.
  • NICE NG12 recommendation 1.8.5 is to consider a suspected cancer pathway referral for an unexplained thyroid lump.

How is this station marked in MRCS Part B?

A physical examination station is marked out of 20 across four domains: clinical and technical skill carries 8 marks, and clinical knowledge and its application, communication, and professionalism carry 4 marks each. The examiner also gives the station a separate global rating of pass, borderline or fail.

Two things follow from that split. More than half the marks sit outside your knowledge of the condition, so a silent, technically correct examination scores poorly. And you are signalled at six minutes of the nine to present your findings, so the sequence has to finish inside six.

How do I start the thyroid examination?

Gel your hands, introduce yourself, gain consent and sit the patient on a chair with the neck fully exposed, with a glass of water within reach. Ask them to sit forward so that you can stand behind them later.

  • Survey from the end of the bed for exophthalmos, a myxoedematous facies, agitation or lethargy, and hoarseness.
  • Look at the hands for tremor, sweating, palmar erythema, thyroid acropachy and onycholysis.
  • Place a sheet of paper on the outstretched hands to make a fine tremor visible.
  • Take the pulse, looking for the tachycardia or atrial fibrillation of thyrotoxicosis and the bradycardia of hypothyroidism.

What do I inspect in the neck?

Look at the neck from the front, then from the side, with the patient's chin slightly raised.

  • A midline or paramedian swelling, its size and symmetry.
  • Scars, including a well-healed collar incision that is easy to miss in a skin crease.
  • Dilated veins over the upper chest, which suggest thoracic inlet obstruction.
  • Skin changes and the position of the trachea.

What do the swallowing and tongue tests show?

Ask the patient to take a sip of water, hold it, then swallow while you watch the swelling. A thyroid swelling rises on swallowing because the gland is tethered to the larynx by the pretracheal fascia.

Then ask the patient to protrude the tongue. A **thyroglossal cyst** is a midline cyst arising from the embryological thyroglossal tract, and it rises on tongue protrusion as well as on swallowing. Look in the mouth at the base of the tongue if a lingual thyroid is suspected.

How do I palpate the thyroid?

Warn the patient, then stand behind them with their neck slightly flexed. Stanford Medicine 25 advises using the finger pads rather than the tips, placing the fingers of both hands just below the cricoid cartilage and meeting in the midline.

  • Feel the isthmus first, then draw the fingers a centimetre or two laterally onto each lobe.
  • Displace the trachea gently towards the side you are examining to bring the lobe forward.
  • Decide whether the gland is diffusely enlarged, multinodular or a solitary nodule.
  • Describe size, surface, consistency, tenderness, and whether the lower border can be felt.
  • Ask the patient to swallow again while you palpate.

Then palpate the cervical lymph nodes systematically: submental, submandibular, pre-auricular, post-auricular, occipital, the anterior and posterior triangles, and supraclavicular. Hard, matted or fixed nodes raise the suspicion of malignancy.

Why percuss and auscultate the thyroid?

Percuss downwards from the suprasternal notch over the manubrium. Dullness suggests retrosternal extension of the goitre, which changes both the airway risk and the operative approach.

Auscultate over each lobe while the patient holds their breath. Stanford Medicine 25 notes that a systolic or continuous bruit over the lateral lobes occurs in hyperthyroidism, particularly Graves' disease, because of the increased vascularity.

What is Pemberton's sign?

**Pemberton's sign** is facial congestion, plethora and distress that appear when the patient raises both arms until they touch the sides of the head, and it indicates obstruction at the thoracic inlet.

Hugh Pemberton described it in retrosternal goitre, and it is also seen with other masses at the thoracic inlet. Offer it when you have found a large goitre or dullness over the manubrium.

How do I assess thyroid status?

  • Hyperthyroid: tremor, sweating, tachycardia or atrial fibrillation, lid lag, lid retraction, weight loss and proximal myopathy tested by asking the patient to stand from sitting with the arms crossed.
  • Hypothyroid: bradycardia, dry coarse skin, slow relaxing ankle reflexes, hoarse voice and periorbital puffiness.
  • Eye signs of Graves' disease: exophthalmos looked for from above and behind, and ophthalmoplegia.
  • Say that you would confirm status with thyroid function tests and assess the lump with ultrasound and fine needle aspiration cytology.

What are the most common mistakes at this station?

  • Palpating from behind without warning the patient first.
  • Not asking for water, so the swallowing test cannot be done properly.
  • Forgetting tongue protrusion, which is the one test that identifies a thyroglossal cyst.
  • Omitting percussion of the manubrium and missing retrosternal extension.
  • Examining the gland and never assessing thyroid status.

MRCS Part B Questions has a thyroid and neck lump station with a marked checklist at /Sample-Questions. Reviewed and updated 15 September 2026.