‘T3 or not T3?’: A poetic guide to the thyroid exam

From the end of the bed, is the patient comfortable at rest?And for the weather are they appropriately dressed?For a goitre or enlargement, be sure to try and see,Then check their behaviour, are they tired or fidgety?Next inspect the hands, for any signs of clubbing,And feel the radial pulse for excessive lub dubbing.To use paper or not, for some is a dilemma,But we all know it helps, when detecting a fine tremor!Before moving to the face, offer to check BP,Then feel around the neck, for lymphadenopathy.Look for dryness of the skin, by now you should know how,As well as any hair loss, in the outer third eyebrow.Protruding eyes or lid lag, both can spell some trouble,Please follow my finger, tell me if you see double?Stick out your tongue, now swallow some drink,Any signs of movement, you should stop and think,Could there be a goitre, or a thyroglossal cyst?These subtle signs are vital and should not be missed!But don’t trust your eyes, stand behind and have a feel.It’s important to be certain any problems seen are real!You’re halfway through the test now, but hold off on that beer!You must ensure you don’t forget, to palpate the trachea.Next tap on the chest, for a goitre retrosternal,Though you only really see this in the Clin Med Journal!Now get your stethy out, and listen to the gland,You better keep an ear out for a bruit underhand!Test next for obstruction, bring their arms upside their head,Danger signs are wheezy breath, or their face a shade of red.Look at the peripheries, for pretibial myxoedema,You're liable to see it, if you look distal to the femur.Time now for some movements, put their arms up like a chicken,If you detect some weakness then the plot begins to thicken.If they find it hard to stand, you will be sure to notice,This symptom is related, to thyrotoxicosis!Move down to the ankle and let that tendon hammer bounce,It will be clear for you to see if the reflex is pronounced!Summarise your findings, thank the patient – you're plain sailing.Remember the stages in these rhymes, you’ve got no chance of failing!

Conflicts of interest

The authors have no conflicts of interest to declare.