Thyroid Status OSCE IC3
“This is an Endocrinology station. You have 5 minutes to assess this patient’s Thyroid Status. I will then
ask you to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent ‘Hi my name is X. I’m a third year medical For the purpose of this guide
• Introduces self with name and level, student at RCSI. What’s your name? Nice to ↑ = associated with hyperthyroidism
explains what he/she will be doing and meet you. I’ve been asked to examine your ↓= associated with hypothyroidism
obtains consent for same
thyroid function today. That will involve
looking and feeling for any abnormalities in
the neck as well as examining you face,
arms and legs. Would that be ok?’
Position and exposure ‘Mr/Mrs A is appropriately positioned and
• Patient seated exposed for this examination.’
• Neck and arms exposed
• Legs bare below the knee
Enquires about pain ‘Are you in any pain?’
• Prior to examining
General Inspection
Patient
Performed from the end of the bed ‘On general inspection Mr/Mrs A appears Pretibial Myxoedema (Graves)
Inspects patient for signs of hyper- and well, with normal colour and body habitus, Tremor (↑)
hypothyroidism no peripheral stigmata of thyroid disease Sweating (↑)
and no equipment around the bed.’ Obvious neck swelling (↑/↓)
Scars
BMI (Low-↑/High-↓)
Colour
Hands & Arms
Examines for clubbing & acropachy Grade X clubbing (↑)
Feels palmar surfaces for warmth, Acropachy (↑)
erythema and sweating Palmar Erythema (↑)
Feels radial pulse & counts heart rate Sweaty Palms (↑)
Asks patient to hold out arms, places ‘On examination of the hands & arms, there Pulse
piece of paper on hands, observing for are no stigmata of thyroid disease evident.’ o Irregular, tachycardia(↑)
fine tremor. o Bradycardia (↓)
Asks patient to hold arms above head Fine tremor of hands (↑)
assessing for facial plethora- Pemberton’s sign is positive
Pemberton’s o Goitre (↑/↓)
o Asks patient elevate both arms
until they touch sides of face,
observes for facial congestion
and cyanosis, as well as
respiratory distress after
approximately one minute.
Eyes
Assesses for signs of eye disease by Signs of Thyroid Eye Disease
observing the eye & eyebrows from in Loss of outer 1/3 of eyebrow (↓)
front & above patient. Periorbital oedema (↑/↓)
Assesses for lid lag by asking the Exophthalmos
patient to follow a finger, moving it ‘On examination of the face, there is no Lid retraction Signs
along the arc of a circle from a point evidence of thyroid eye disease.’ Lid lag specific to
above patient’s head to a point below Chemosis Graves
their nose Eyelid swelling / erythema
Assesses extraocular movements by
asking patient to follow examiner’s
“This is an Endocrinology station. You have 5 minutes to assess this patient’s Thyroid Status. I will then
ask you to present your findings and answer a question”.
Examination Expected/Normal Comments Potential/Abnormal Comments
Introduction
Hand hygiene
• Cleans hands with alcohol gel
Introduction, explanation and consent ‘Hi my name is X. I’m a third year medical For the purpose of this guide
• Introduces self with name and level, student at RCSI. What’s your name? Nice to ↑ = associated with hyperthyroidism
explains what he/she will be doing and meet you. I’ve been asked to examine your ↓= associated with hypothyroidism
obtains consent for same
thyroid function today. That will involve
looking and feeling for any abnormalities in
the neck as well as examining you face,
arms and legs. Would that be ok?’
Position and exposure ‘Mr/Mrs A is appropriately positioned and
• Patient seated exposed for this examination.’
• Neck and arms exposed
• Legs bare below the knee
Enquires about pain ‘Are you in any pain?’
• Prior to examining
General Inspection
Patient
Performed from the end of the bed ‘On general inspection Mr/Mrs A appears Pretibial Myxoedema (Graves)
Inspects patient for signs of hyper- and well, with normal colour and body habitus, Tremor (↑)
hypothyroidism no peripheral stigmata of thyroid disease Sweating (↑)
and no equipment around the bed.’ Obvious neck swelling (↑/↓)
Scars
BMI (Low-↑/High-↓)
Colour
Hands & Arms
Examines for clubbing & acropachy Grade X clubbing (↑)
Feels palmar surfaces for warmth, Acropachy (↑)
erythema and sweating Palmar Erythema (↑)
Feels radial pulse & counts heart rate Sweaty Palms (↑)
Asks patient to hold out arms, places ‘On examination of the hands & arms, there Pulse
piece of paper on hands, observing for are no stigmata of thyroid disease evident.’ o Irregular, tachycardia(↑)
fine tremor. o Bradycardia (↓)
Asks patient to hold arms above head Fine tremor of hands (↑)
assessing for facial plethora- Pemberton’s sign is positive
Pemberton’s o Goitre (↑/↓)
o Asks patient elevate both arms
until they touch sides of face,
observes for facial congestion
and cyanosis, as well as
respiratory distress after
approximately one minute.
Eyes
Assesses for signs of eye disease by Signs of Thyroid Eye Disease
observing the eye & eyebrows from in Loss of outer 1/3 of eyebrow (↓)
front & above patient. Periorbital oedema (↑/↓)
Assesses for lid lag by asking the Exophthalmos
patient to follow a finger, moving it ‘On examination of the face, there is no Lid retraction Signs
along the arc of a circle from a point evidence of thyroid eye disease.’ Lid lag specific to
above patient’s head to a point below Chemosis Graves
their nose Eyelid swelling / erythema
Assesses extraocular movements by
asking patient to follow examiner’s
