in a young thin person the thyroid may be visible just below the cricoid cartilage.
the isthmus is usually only visible - as a diffuse central swelling.
enlargement of the gland - a goitre - should be apparent on inspection - this may be localised or generalised.
ask the patient to sip some water and carefully watch the neck swelling. Only a goitre or thyroglossal cyst will rise on swallowing because of attachment to the larynx. Swallowing also reveals the shape of the gland better.
inspect the neck for scars. A scar forming a ring around the base of the neck in the position of a high necklace may be the result of a thyroidectomy. Dilated veins over the upper part of the chest wall suggest retrosternal expansion of the goitre (thoracic inlet obstruction). Suppurative thyroiditis may cause redness of the skin over the thyroid.
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