The typical thyroid swelling in exophthalmic goiter presents throbbing, thrill, and bruit—physical signs of hyperplasia of the organ associated with a tremendous increase in its vascularity. These signs, especially bruit, help to differentiate this form of goiter from that of toxic adenoma. Indeed, in the absence of exophthalmos in an otherwise typical case of exophthalmic goiter, the characteristic bruit of the thyroid is almost pathognomonic. The stethoscope over the thyroid gland is frequently the determining factor in differentiation of the two conditions, which otherwise present many clinical features in common.
The examiner must place the stethoscope over the isthmus of the organ rather than over the lateral lobes. At the isthmus the true bruit of the thyroid is obtained rather than the sound of blood passing through the carotid arteries. Carotid murmurs are systolic in time, of the same duration as the cardiac systole and rather soft in character. Bruit