How accurate is the assessment of thyroid volume by palpation? A prospective study of 316 patients

Goitre is the cardinal symptom of most thyroid diseases and treatment is often influenced by the evaluation of thyroid size. Quantitative palpation of the thyroid gland could offer a quick and easy initial examination method for discovering most thyroid diseases. However, this clinical technique is frequently underestimated and its accuracy is not evaluated. Therefore, we examined the question whether thyroid volume can be determined with sufficient precision by manual palpation. 316 patients with suspected thyroid diseases were selected at random at our hospital and prospectively studied. Thyroid volume of each patient was assessed by palpation followed by ultrasonically scanning. The examinations were performed by two physicians: an endocrinologist (A) and a resident (B) who had undergone a structured palpation training. Ultrasonic scanning of 99 thyroid glands revealed a high level of agreement (r2 = 0.87) between both physicians. Examiner A evaluated 111 patients by palpation and ultrasonic scanning. The mean volume determined by ultrasound was 35.9 ml (SD = 27.1 ml) with a range of 4-152 ml. This correlated well with the results of palpation (r2 = 0.872). Examiner B evaluated 215 patients. These ultrasonically determined volumes had a mean value of 37.3 ml (SD = 24.2 ml; range 4-145 ml) and correlated well with the results obtained by palpation (r2 = 0.856). A total of 53 patients were examined by both physicians. The interobservers' comparison of the palpation results yielded an excellent correspondence (r2 = 0.893). We conclude that the manual palpation technique yields sufficiently precise quantitative results for clinical purposes and can be taught. Clinical assessment of thyroid size on a routine basis should result in better diagnostic strategies for thyroid diseases and in cost savings.