Thyroid case presentation MULTINODULAR GOITRE.pptx

CASE PRESENTATION OF THYROID SWELLING

1. Thyroid case presentation

2. Mrs.lakshmi , 55yr old female who is a housewife coming from thiruvannamalai , with chief complaints of : Swelling in front of neck for past 1 month.

3. No history suggestive of pressure symptoms like no h/o dyspnoea No h/o dysphagia No h/o change in voice No h/o sugesstive of horner syndrome No h/o syncope

4. History of presenting illness The patient is apparently normal before 1 month. After which shen noticed small swelling on the anterior aspect of neck which was insidious in onset and non progressive in size . Not associated with pain No h/o any other swelling No h/o fever

5. No h/o sugesstive of hyperthyroidism like : No h/o excess sweating No h/o loss of weight inspite of good appetite No h/o diarrhoea No h/o sleepless night No h/o muscle weakness No h/o tremors No h/o palpitations No h/o dyspnoea on exertion

6. No history suggestive of hypothyroidism : No h/o weight gain inspite of poor appetite No h/o constipation No h/o cold intolerance No h/o easy fatiguability

7. No h/o suggestive of malignancy : No h/o sudden increase in size No h/o loss of appetite and weight loss No h/o bone pain No h/o jaundice No h/o cough with hemoptysis No h/o headache , convulsions , seizures.

8. Past history No h/o similar illness in the past Not a known case of diabetes, hypertension ,asthma, epilepsy, tuberculosis, ischemic heart disease. No h/o irradiation No h/o previous surgery No h/o drug intake .

9. Personal history Mixed diet No adverse social habits Takes iodised salt No h/o excess intake of goitrogens No h/o altered sleep pattern

10. Menstrual history Attained menarche at 14 years of age Normal flow, regular – 3 / 30 days cycle , not associated with pain and clots . Attained menopause 10 years back at the age of 45. OBSTETRIC HISTORY : P2L2 A0 both are full term normal vaginal delivery. no h/o sterilization surgery done .

11. FAMILY HISTORY : NO HISTORY OF SIMILAR COMPLAINTS IN THE FAMILY.

12. GENERAL EXAMINATION Conscious , oriented , comfortable , cooperative Moderately built and nourished Afebrile No pallor Not icteric No cyanosis, clubbing , pedal edema , lymphadenopathy . Eyes - normal

13. VITALS : BP – 110/70 mmHg RR- 17/min PR – 72/min , regular in rhythm , normal in volume , no radio-radio, no radio femoral delay. Temperature -98 degree fahrenheit

14. Local examination Inspection : swliing in the anterior aspect of the neck in the region of thyroid of size – 3*3 cm lower border is seen swelling moves with deglutition oval in shape surface appears to be smooth margins well defined skin over the swelling normal No scars, no sinus , no dilated veins No visible pulsations Trachea appears to be in midline .

15. Palpation : Not warm ; Not tender Swelling of size 3*2cm in the anterior aspect of neck on the region of thyroid , oval in shape. Lower border extending 2cm away from suprasternal notch , 1cm below hyoid bone, right side 2cm away from anterior border of sternocleidomastoid , left side lies close to anterior border of sternocleidomastoid muscle . Surface smooth, colloid in consistency Plane of the swelling : deep to deep fascia

16. Carotid pulsation : felt against the upper border of thyroid cartilage equal intensity on both sides. No palpable thrill Trachea in midline No other swelling present . Percussion : no retrosternal dullness Auscultation : no bruit heard

17. Examination of lymph nodes : No palpable lymph nodes in the neck region. OTHER SYSTEMIC EXAMINATION : CVS- S1 S2 + RS – B/L AE + CNS – NFND SPINE AND CRANIUM – NORMAL.

18. SUMMARY A 55 YEAR OLD FEMALE WITH COMPLAINTS OF SWELLING IN THE ANTERIOR ASPECT OF THE NECK FOR THE PAST 1 MONTH WITH NO HISTORY OF PRESSURE SYMPTOMS , HYPOTHYROIDISM , HYPERTHYROIDISM, MALIGNANCY, AND METASTASIS. DIAGNOSIS : a case of non toxic , non malignant , multinodular goitre without complications.