Stand >1m away from patient and have patient follow your finger without moving their head
Positive test: lids will move more slowly than the eyes
Normally, they should be moving simultaneously
Pemberton’s Sign
Have patient raise their arms above head for 1 minute
Look for signs of facial congestion and cyanosis, respiratory distress
This indicates venous obstruction which can be due to many things, one of which is a large goiter.
Proximal Muscle Weakness
Have patient stand up from a chair without using their arms
Alternative: lift up their arms against resistance
Proximal muscle weakness can be seen in hypothyroidism
Deep Tendon Reflexes
Assess bilateral symmetry and briskness of response
Patellar reflex
Brachialis reflex
Triceps reflex
Achilles reflex
Grading: 0 is absent (abnormal), 1+ is slight (normal or abnormal), 2+ is brisk (normal set point), 3+ is very brisk (normal or abnormal), 4+ is clonus (repeating reflex, abnormal)
Typical Presentations:
Hyperreflexia (3+ or 4+) characteristic of Hyperthyroidism
Hyporeflexia (0 or 1+), specifically a delayed relaxation phase, is characteristic of Hypothyroidism most easily seen at ankle reflex
Stethopedia 