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 pa lpation of the thyroid gland could offer a quick and easy initial exam ination method for discovering most thyroid diseases. However, this cl inical 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 p atients with suspected thyroid diseases were selected at random at our hospital and prospectively studied. Thyroid volume of each patient wa s assessed by palpation followed by ultrasonically scanning. The exami nations were performed by two physicians: an endocrinologist (A) and a resident (B) who had undergone a structured palpation training. Ultra sonic scanning of 99 thyroid glands revealed a high level of agreement (r(2) = 0.87) between both physicians. Examiner A evaluated 111 patie nts by palpation and ultrasonic scanning. The mean volume determined b y ultrasound was 35.9 ml (SD = 27.1 ml) with a range of 4-152 ml. This correlated well with the results of palpation (r(2) = 0.872). Examine r B evaluated 215 patients. These ultrasonically determined volumes ha d a mean value of 37.3 ml (SD = 24.2 ml; range 4-145 ml) and correlate d well with the results obtained by palpation (r(2) = 0.856). A total of 53 patients were examined by both physicians. The interobservers' c omparison of the palpation results yielded an excellent correspondence (r(2) = 0.893). We conclude that the manual palpation technique yield s 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.