The Small and Mighty Thyroid Gland

Palpating for irregularities is important in routine preventive screening of all patients

Janiece C. Ervin, RDH, BSDH

If you cut a small plum in half, that's about the size of each of the lobes of the thyroid gland that lie on either side of the windpipe. These lobes are bridged together by tissue called the isthmus. The thyroid gland is situated in the front of the neck just below the Adam's apple. This small but mighty gland regulates the entire body. The hormones secreted by the thyroid regulate the speed with which the body's cells work. These thyroid hormones control the body's metabolism, which affects heartbeat, energy levels, digestion, temperature, and thoughts and feelings. According to the American Thyroid Association, 12% of the U.S. population will develop a thyroid condition in their lifetime, 60% of those with thyroid disease are unaware of their condition, and 1 in 8 women will develop thyroid disease in their lifetime.¹

Symptoms of the two most common thyroid diseases—hypothyroidism and hyperthyroidism—are sometimes dismissed or confused with other ailments because of the wide range of symptoms that can be experienced. Signs of thyroid disease are as follows:

Symptoms of hypothyroidism^2,3

• Tiredness

• Weight gain

• Feeling cold

• Constipation

• Dry or thinning hair

• Muscle weakness or aches

• Hoarse voice

• Pins and needles in the hands

• Slow speech, movement, and thought

• Low mood/anxiety

• Memory problems

• Concentration problems

Symptoms of hyperthyroidism^2,3

• Racing heartbeat

• Weight loss

• Feeling sweaty and shaky

• Feeling uncomfortably hot

• Diarrhea

• Thirst

• Itchiness

• Mood swings

• Feeling anxious and irritable

• Concentration problems and restlessness

Thyroid disease is diagnosed via blood screenings, ultrasound, neck examination, and a review of the patient's symptoms. The neck examination is a responsibility that dental professionals are required to perform as part of the intraoral and extraoral examinations of each patient. However, finding the thyroid on a patient can be difficult if you are not clear on where in the neck it is located. It is therefore important for dental professionals to familiarize themselves with the best practices of thyroid examinations.

When palpating the thyroid gland, clinicians should be looking for size, symmetry, consistency, and masses. Ask yourself: Does the thyroid feel enlarged? Is there asymmetry between the lobes? Are there any irregularities of the thyroid tissue? If a mass is found, note the position, shape, consistency, and mobility of it.

Stanford Medicine provides an easy-to-follow written explanation on how to find the thyroid and complete an exam on either yourself or your patient.⁴ Finding the thyroid is best accomplished using the following step-by-step examination, which is shared here verbatim from the Stanford Medicine website:

Palpation of the thyroid⁴

1. Put your finger on tip of the chin (mentalis).

2. Slide your finger down the midline, and the first hard structure you hit is the top of the thyroid cartilage. (Surprisingly, one does not feel the hyoid bone in the midline, although sometimes its lateral end is misidentified as a hard lymph node.)

3. Run your finger down the prow or the free edge of the thyroid cartilage (Adam's apple).

4. The next thing you hit is the cricoid cartilage (and see if you can get your fingernail in between the thyroid and cricoid cartilage-that is the cricothyroid membrane which is where trans-tracheal aspirations for pneumonia can be performed).

5. Below the cricoid ring are the first two rings of the trachea, and the isthmus of the thyroid overlies those two rings.

6. Ask the patient to flex the neck slightly forward and relax.

7. Go through the landmarks as above.

8. Place the first two digits of both hands just below the cricoid cartilage so that the left and right fingers meet on the patient's midline. Place thumbs posterior to the patient's neck and flatten all fingers against the neck.

• Use finger pads, not tips, to palpate.

• Identify the isthmus.

9. Gently draw fingers laterally 1 cm to 2 cm.

• Gently palpate lateral lobes.

10. Now ask the patient to swallow (give them a glass of water if possible).

• Assess for asymmetrical elevation of lobes (suggests nodularity).

11. When you are done with the above, move to the next phase, which is displacing the soft tissues on one side to the midline while assessing for size with the other hand. Repeat in opposite direction.⁴

Reviewing the procedures of the thyroid examination as well as the symptoms of common thyroid diseases will allow dental professionals to perform neck examinations to a higher standard and provide patients with better, more thorough preventive care in the dental office.

About the Author

Janiece C. Ervin, RDH, BSDH, is the founder of the Dental Explorer Network in Denver, Colorado.

References

1. American Thyroid Association. General information/press room. ATA website. https://www.thyroid.org/media-main/press-room/. Accessed March 6, 2023.

2. Bjerkreim BA, Hammerstad SS, Gulseth HL, et al. Thyroid signaling biomarkers in female symptomatic hypothyroid patients on liothyronine versus levothyroxine monotherapy: a randomized crossover trial. J Thyroid Res. 2022;2022:6423023.

3. Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. StatPearls; 2022.

4. Stanford Medicine. Thyroid exam. Stanford Medicine 25 website. https://stanfordmedicine25.stanford.edu/the25/thyroid.html. Accessed March 6, 2023.