1. Observe: exophthalmos, goitre, neck scar, thyroid acropachy, pretibial myoedema
2. Get patient to stretch out hands for tremor (put a piece of paper on the dorsum if not obvious)
3. Feel the hands for warmth and check pulse for rate and character
4. Examine the neck and feel the goitre (get patient to swallow some water), listen for bruit
5. Examine the eyes for lid lag
6. Examine the tendon reflexes
The thyroid status is often asked in the examination after you have examined a patient with thyroid eye disease. In the majority of cases, the patient is euthyroid.
Thyroid eye disease is associated with Grave's disease and therefore look out especially for acropachy and pretiabial myxoedema (the last two plus the eye signs form the triad of Grave's disease)
Donot forget to revise the medication used in treating hyperthyroidism
which are propyluracil, carbimazole and radioactive iodine and their inviidual
side effects such as agranulocytosis with propyluracila and carbimazole;
and hypothyroidism with radioactive iodine.