Place your hand on any visible swelling whilst standing in front of the patient - will confirm visual impression of shape, size and surface. Also it will identify if areas of (or the whole) thyroid is tender.
Check the position of the trachea (tip of two fingers in the suprasternal notch). If there is extension of the thyroid mass below the suprasternal notch and the trachea is obscured then the thyroid cartilage must be examined. If there is a mass displacing the trachea then this will tilt the thyroid cartilage laterally.
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