The physical examination is usually performed with the patient standing or sitting. The following examinations are performed:
- Externally visible signs of disease (inspection) include swollen legs, pale, doughy skin, or shaggy hair.
- With the palpation (palpation), the doctor can determine the size and displacement of the thyroid gland, feel larger tissue changes such as nodules and check whether the organ hurts (for example, inflammation).
- With the stethoscope for listening (auscultation), buzzing sounds can be perceived over areas with a strong blood supply.
- If the doctor suspects a calcium deficiency in the blood (caused by hypothyroidism), he can detect the resulting hyperexcitability of nerves and muscles, for example, by tapping (percussion) of a facial muscle.
Blood samples for examination of the thyroid gland
If there is a suspicion of thyroid or parathyroid disease, the next steps are blood tests to look for dysfunction and ultrasound examination to better assess the tissue:
Laboratory diagnostics using a blood test are highly valued in hormonal disorders.
- Suspected thyroid disorders: First, the concentration of the messenger substances thyroxine (thyroid hormone) and TSH (hormone of the pituitary gland that stimulates the production of thyroid hormones) is determined. Depending on how, how much and in what proportion these values are changed, it can already be distinguished whether there is an over- or underfunction and whether the cause is in or outside the thyroid gland.
- Suspicion of epithelial body disorders: Determined are parathyroid hormone (the messenger substance formed in the parathyroid glands) and calcium (which is affected by it). Also here succeeds – as with the thyroid gland – so an initial distinction of the cause of the dysfunction.
Ultrasound examinations of the thyroid gland
Ultrasound (sonography) is a procedure that is not harmful to the patient, which allows more accurate information about the size and condition of the thyroid gland.
For example, local processes such as cysts, tumors bleeding and calcifications, but also diffuse changes such as nodular remodeling of the tissue can be detected. Pathological processes in the epithelial cells can also be detected with modern high-resolution ultrasound equipment.
If necessary, for example in the case of suspected tumors, tissue samples can be taken under ultrasound guidance (fine needle biopsy) and then examined under the microscope. With an additional device, Doppler and duplex sonography can be used to make the blood flow visible and audible in color and thus assess the vessels and blood supply.