Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Multinodular Goitre Clinical Examination Discussion and Treatment
maker from madampakkam belonging to
lower socioeconomic class presented with
chief complaints of swelling in the front of
neck for the past 2 months.
HISTORY OF PRESENTINGILLNESS
?The patient was apparently normal 2
months back after which she noticed
swelling in the front of neck,
-insidious in onset
-initially small in size gradually
progressed to current size.
?not associated with pain
?Difficulty in swallowing for past 1 month more for
solid foods
?No h/o breathlessnes
?No h/o hoarseness of voice
?No h/o dyspnea/stridor
?N0 h/o syncopal attack
?No h/o suggestive of horner's syndrome
?No h/o weight loss/weight gain
?No h/o diarrhoea/constipation
?No h/o heat/cold intolerance
?No h/o insomnia/sleep disturbances
?No h/o oligomenrrhea/menorrhagia
?No h/o excessive sweating,diplopia
?No h/o tremors,muscle weakness
?No h/o palpitations,chest pain,pedal edema
?No h/o loss of weight, loss of appetite
?No h/o cough with hemoptysis,
?No h/o bone pain
?No h/o swelling elsewhere in the body
PAST HISTORY
?No h/o similar complaints in the past
?No h/o previous suergry or hospitalisation
?No h/o DM/HT/TB/asthma/epilepsy/jaundice
?No h/o neck irradiation in childhood
?No h/o allergy to drugs/food
PERSONAL HISTORY
?Consumes non veg diet
?Normal bowel and bladder habits
?Not an alcoholic/smoker
?No addictive habits
?Consumes iodinized salt
?Consumes too much cabbage,soyabeans, sea food
MENSTRUAL HISTORY
?Age at menarche ? 14
?Regular cycles
?Normal flow 3/28
?not associated with clots
FAMILY HISTORY
?No significant family history
GENERAL EXAMINATION
Patient is conscious,oriented,moderately built and
nourished.
No pallor
No icterus
No cyanosis
No clubbing
No pedal edema
No generalised lymphadenopathy
No signs of hyper/hypothyroidism
VITAL SIGNS
PR-76/min,regular in rhythm,normal volume, no
specific character,no radioradial,radiofemoral
delay,felt in all peripheral pulses,nature of vessel wall
normal
RR-18/min, thoracoabdominal type
BP-130/70mm Hg measured in right upperarm,sitting
posture
Afebrile
LOCAL EXAMINATION
? After getting consent from the patient,she was examined
in sitting posture under bright light
?EXAMINATION OF THYROID
INSPECTION
?A swelling of 6*5cm in the front of neck,butterfly
shaped,in the region of thyroid,extending 2cm from
suprasternal notch,upper border 2cm from oblique
line of thyroid cartilage,extends upto anterior border
of sternocledomastoid on both sides.
?Surface appears to be smooth,skin over swelling
normal,well defined margin,lower border can be seen,
?No scar,sinuses,dilated veins,visible pulsation
?Moves with deglutition
?No movement with protrusion of tongue
?Trachea appears to be in midline
PALPATION
? Not warmth,not tender
? Inspectory findings of site,size,shape,extent are confirmed
? 2 nodules palpable on either lobe of thyroid gland.
nodule on left side: single nodule of size 1*1 cm hemispherical in
shape present on left lobe.
EXTENT- 4cm above sternum
-0.5 cm from midline
-2cm from thyroid cartilage
nodule on right side: another noule of size 1*2 cm hemispherical
in shape present in right lobe.
EXTENT- 2cm from sternum
-0.5cm from midline
-3cm from thyroid cartilage
? both nodules are soft to Firm in consistency, surface ?
smooth,margin- well defined,mobile,moves with
deglutition
Trachea in midline
Kochers test ?ve
Berry's sign ?ve
Carotid pulsations felt on both sides equally
No plapable thrill
No regional lymph nodes palpable
PERCUSSION
normal resonant note over manubrium sternum
AUSCULTATION
no bruit
OTHER SYSTEM EXAMINATION
RS: normal vesicular breath sound heard, no added
sounds
CVS: s1 s2 heard, no murmur
CNS:no focal neurological deficit
ABDOMEN:soft,non tender,no organomegaly,no free
fluid,hernial orifice free
SPINE AND CRANIUM: normal
DIAGNOSIS: non toxic.non malignant, multinodular
goitre in euthyroid state,with pressure symptom
MANAGEMENT
INVESTIGATIONS:
ROUTINE:
blood: complete hemogram-TC,DC,Hb%,ESR,BT,CT
blood urea,sugar,creatinine
urine: sugar,albumin
xray chest,ecg
SPECIFIC:
xray neck,CT neck
usg neck,radioactive iodine uptake study
ENT examination,
thyroid profile,thyroid antibodies,thyroglobulin
thyroid scan
FNAC
indirect laryngoscopy
TREATMENT
TOTAL THYROIDECTOMY
SUBSTITUTION THYROXINE 0.2 mg/day
This post was last modified on 08 August 2021