Does thyroid gland examination by palpation alter serum hormone levels?

Does thyroid gland examination by palpation alter serum hormone levels?
Sema Zer Toros, MD 1 *, Leyla Ozel, MD 2, Mehmet Murat Yekrek, MD 3, Ahmet Burak Toros, MD 4, Bars Naiboglu, MD 1, Melih Kara, MD 2, Erdal Erdodu, MD 2, Erol Egeli, MD 1, zzet Titiz, MD 2
1Department of Otorhinolaryngology/Head and Neck Surgery, Istanbul, Turkey
2Department of General Surgery, Istanbul, Turkey
3Department of Biochemistry, Haydarpaa Numune Educational and Research Hospital; Istanbul, Turkey
4Department of Internal Medicine, Istanbul Educational and Research Hospital, Istanbul, Turkey
email: Sema Zer Toros (semazertoros@yahoo.com)
*Correspondence to Sema Zer Toros, M. Saadettin Sokak, Saadet Apartmen, No:3D:4, Ortaköy/Beikta Istanbul, Turkey

The authors have no funding, financial relationships, or conflicts of interest to disclose.
KEYWORDS
Thyroid • thyroid hormones • palpation • Level of Evidence: 2c
ABSTRACT

Objectives/Hypothesis:
The goal of this study was to investigate the effects of routine thyroid gland palpation on serum thyroid hormone levels.

Study Design:
Prospective study at Haydarpaa Numune Research and Education Hospital, Istanbul, Turkey.

Methods:
This study was carried out in two groups with a total of 50 consecutive adults. Group I consisted of 20 patients (12 female and 8 male, aged 20-48 years) with a diagnosis of nodular thyroid disease confirmed by ultrasound imaging techniques. The second group consisted of 30 otherwise healthy subjects (17 female and 13 male, aged 18-50 years) referred for neck and thyroid ultrasound and with no thyroid pathology detected. Thyroid gland palpations were performed by the same physician. Blood samples were obtained before and 2 hours after thyroid gland palpation. Serum total T3 (TT3), total T4 (TT4), free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), and thyroglobulin (TG) measurements were made.

Results:
We found that routine palpation in the first group caused a significant increase in serum TT3 (P < .05), FT3 (P < .01), FT4 (P < .05), and TG (P < .05) levels. In the second group, TT3 (P < .01), FT3 (P < .05), FT4 (P < .05), and TG (P < .05) levels also increased significantly after palpation. Differences in TSH and TT4 levels were not significant in any of the groups (P > .05).

Conclusions:
Preliminary data proposing a possible effect of routine thyroid gland palpation on serum thyroid hormone levels suggest that serum thyroid hormone measurements should be performed before any manipulation of the gland, including palpation, to avoid misdiagnosis. Laryngoscope, 2010