Berry’s sign, in thyromegaly

Eishatur Rodhiah Mamat and Edward Tan Hong Swo, Year 3, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia

22 April 2016

Berry’s sign is named after a British surgeon, Sir James Berry, who was the first to describe it.

Berry’s sign is the absence of carotid pulsation on palpation [Heston and Wahl, 2010]. The absence of carotid pulsation in a patient presenting with a thyroid swelling suggests malignancy.

Eliciting the sign

Ask the patient to extend the neck (best if the patient is sitting, as a proper extension is difficult with the patient lying down). Palpate the carotid is at the level of upper border of thyroid cartilage just anterior to the sternocleidomastoid [Saha, 2013]. (It’s safer not to palpate both sides simultaneously. Pressure on the carotid can slow the heart, and bilateral pressure can cause dangerous slowing [McConachie, 1987].) The carotid pulse of both sides of the neck should be palpated separately to avoid imposing discomfort on the patient.[Saha 2013].

An enlarged thyroid (in goiters) may displace the carotid artery posteriorly. The absence of carotid pulsation upon palpation is a positive Berry’s sign [Babu 2013].


Berry’s sign indicates the presence of infiltration of the carotid sheath by a malignant thyroid swelling [Saha 2013]. As the carotid is encased by the malignant tumour, its pulsation will be masked. A benign thyroid enlargement usually does not infiltrate the carotid sheath [Heston and Wahl, 2010]. Therefore, Berry’s sign is useful in differentiating between a malignant and a benign thyromegaly.


  • Babu RD. Clinical surgery pearls. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2013, p25.
  • Heston TF, Wahl RL. Molecular imaging in thyroid cancer. Cancer Imaging [Internet]. 2010 [cited 2016 Mar 30];10(1):1-7. Available from doi: 10.1102/1470-7330.2010.0002.
  • McConachie I. Value of pre-operative carotid sinus massage. Anaesthesia 1987;42:636-8
  • Saha ML. Bedside clinics in surgery.2nd ed. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2013, p249.
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