I'm now going to demonstrate the thyroid exam the key to the thyroid exam is knowing the anatomy so if you follow along with me and put your finger on the tip of your chin on the mentalis muscle and then slide your finger down the midline the first hard structure you hit will be the thyroid cartilage or the Adam's apple you're actually going over the hyoid bone but you generally don't feel it very clearly in the midline so the first thing you hit is the top of the thyroid cartilage slide your finger down the edge of the thyroid cartilage like the prow of a ship and you will next hit the cricoid cartilage and this is the cricothyroid membrane and then below the cricoid cartilage will be the first two rings of the trachea it's important to know this Anatomy because the thyroid gland does not really lie anywhere near the thyroid cartilage despite the name the exam is best done by getting behind the patient and once again using my Anatomy finding the thyroid cartilage the cricoid cartilage the first two rings of the trachea I then put my fingers in the midline over the first two the rings of the trachea that's where the Isthmus of the thyroid lies I then flatten my fingers it's almost as though I'm trying to choke the patient and I slide my finger slightly to the side and now I ask the patient to swallow and I'm concentrating on whether one hand went one set of fingers went up disproportionately compared to the other once I've done that a couple of times I can then push the thyroid gland over with one hand and palpate the lobes with the other hand and then do the same thing this way don't forget while you're at it to do a complete lymph node exam and also to look at the hand to see if it's sweaty and if there is a fine tremor the preceding program is copyrighted by the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu