Thyroid malignancy (prototype case).pptx

Thyroid case

1. Surgery clinical case presentation MENTOR: Prof. DR. SRINIVASAN SIR PRESENTED BY: SIDHARTH SKANDHA FINAL YEAR MBBS COIMBATORE MEDICAL COLLEGE AND HOSPITAL

2. CASE HISTORY NAME : Mrs. ABC AGE : 55 years SEX : Female OCCUPATION : Homemaker ADDRESS : Coimbatore DATE OF EXAMINATION : 24/10/2021

3. CHIEF COMPLAINTS Swelling in front of the neck since 3 years

4. HISTORY OF PRESENTING ILLNESS Patient was apparently normal 3 years ago. She noticed a swelling in front of the neck incidentally, 3 years ago. The swelling was insidious in onset and progressive in nature and rapidly increasing in size since 1 year, and attained the present size Associated with difficulty in swallowing since 3 month History of pain in the swelling since 3 months – dull aching in nature Associated with hoarseness in voice since 1 month

5. No H/O difficulty in breathing No history of Bone pain, No history of cough and hemoptysis No history suggestive of Hypo or hyperthyroidism No history suggestive of horner’s syndrome Presently not a COVID 19 positive patient

6. PAST HISTORY No similar complaints in the past No history of Diabetes , Hypertension , TB No history of epilepsy No history of previous exposure to radiation No history of previous surgical intervention

7. TREATMENT HISTORY Not on any medications No history of any Drug allergy

8. FAMILY HISTORY No similar complaints in the family No history suggestive of thyroid diseases in the family

9. MENSTRUAL HISTORY Patient had attained menopause 10 years ago

10. PERSONAL HISTORY DIET : vegetarian diet on iodized salt , No excessive consumption of brassica group of vegetables. APPETITE : Normal SLEEP : Adequate BOWEL AND BLADDER MOVEMENTS : Normal NO History of Smoking and drinking

11. SUMMARY A 55 Year old woman has presented with the complaint of swelling in front of the neck since 3 years, suddenly increasing in size for 1 year, which is Associated with dull aching pain, dysphagia and hoarseness of voice, probably it could be a malignant swelling arising from thyroid

12. GENERAL EXAMINATION An Informed Consent was taken from the patient and the examination was done in the presence of a female attender, in adequate natural light and exposure of the neck . Patient was moderately built and nourished She is comfortable in sitting position . Conscious, well oriented to time ,place and person and responds verbally

13. PALLOR- Absent ICTERUS- Absent CYANOSIS- Absent CLUBBING- Absent GENERALIZED LYMPHADENOPATHY- Absent EDEMA- Absent

14. VITALS PULSE : 78 beats/min , regular , with Normal character and volume , No radioradial and radiofemoral delays , all the peripheral pulses are felt and are Normal RESPIRATORY RATE : 16 breaths/min SPO2 : 98 % TEMPRATURE : 98.6 F BLOOD PRESSURE : 110/70 mmHg

15. LOCAL EXAMINATION INSPECTION : Swelling in front of the neck involving the left lobe and extending onto the isthmus Looks hemispherical Swelling moves with Deglutition, restricted mobility Approximately 12x12cm in size Lower border of the swelling is not appreciable on inspection

16. Skin over the swelling is normal No engorged veins Pemberton sign negative No surgical scars

17. PALPATION No warmth or tenderness over swelling Inspectory findings are confirmed on palpation Uneven surface with distinct margins Variegated Consistency Lower Border of swelling is palpable Trachea is palpable in the midline Skin pinchable

18. Lymph nodes not appreciable on the left side and not palpable on the right side. Kocher’s test is negative. Carotid pulsation is felt on both sides equally. (Berry’s Sign Negative) No pulsation or thrill on the thyroid gland

19. AUSCULTATION No appreciable Bruit on the thyroid gland

20. SYSTEMIC EXAMINATION Cardiovascular system : 1 st and 2 nd heart sounds heard, no murmurs Respiratory system : Normal vesicular breath sounds heard, No added sounds Central Nervous system : Clinically Normal Per Abdomen : Normal Skeletal System : normal

21. PROVISIONAL DIAGNOSIS Malignant thyroid swelling

22. Thank you