Checklist

WIPER

• Patient on chair, away from wall, both clavicles exposed.

• Examine from the front, sides and behind the neck.

• Glass of water available.

Physiological parameters

General

• Hoarse voice or stridor

• Position of the head: sternocleidomastoid tumour or torticollis

• Open mouth: thyroglossal cyst, lingual thyroid, ranula, cystic hygroma

Inspection

• Scars or radiotherapy tattoo

• Sinuses, fistulas or erythema

• Masses/swellings

• Distended neck veins: SVC obstruction or compression

• Protrusion of tongue: rule out mobile masses or hypoglossal/lingual nerve pathology

• Swallow water: rule out mobile masses (thyroglossal cyst), cough or dysphagia

• Blow nose: identify laryngocoele

Palpation

Ask: ‘Do you have any pain?’

From behind:

• Temperature and tenderness

• Lumps:

• during swallowing

• whilst patient is protruding tongue

• during coughing

• Submandibular and parotid glands

• Trachea: central or deviated

• Thyroid: goitre, discrete masses, tenderness

• Carotids: pulsatile masses or obliterated pulse (Berry's sign)

• Lymph nodes

Percussion

• Retrosternal goitre

Auscultation

• Thyroid bruit (thyrotoxicosis)

• Carotid bruit (see Chapter 24, Examination of the carotid artery)

• Gurgling in pharyngeal pouch

To complete the examination…

• Perform Pemberton's test.

• Examine the oral cavity, ear, nose and throat.

• Visualise vocal cords directly.

• Examine thyroid status.

Checklist

WIPER

Physiological parameters

General

• Weight status

• Mood: agitated, nervous, lethargic

• Hair: fine or coarse

• Clothing

Hands

• Pseudoclubbing of nails (thyroid acropachy)

• Onycholysis (Plummer's nails)

• Palmar erythema

• Palmar sweating

• Fine tremor

• Pulse: tachycardia, AF

Eyes

• Hair loss outer eyebrow

• Periorbital oedema

• Lid retraction (Dalrymple's sign)

• Exophthalmos/proptosis

• Chemosis/conjunctival injection

• Lid lag/ophthalmoplegia

Arms

• Proximal myopathy

Legs

• Pretibial myxoedema (Grave's disease)

• Slow relaxing ankle reflexes

Thyroid exam

• Full examination of neck and thyroid gland

To complete the examination…

Conclude on thyroid status: euthyroid/hyperthyroid/hypothyroid.