Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Solitary Nodule Thyroid Clinical Examination Discussion and Treatment
34 Year old lady , Mrs Saridha , House maid , coming
from Mugappair belongs to low socio economic class
C/O :
Swelling in the front of neck for 3 month
H/O Presenting illness
The patient was apparently normal 3 month
ago after which she developed a swelling in front of
the neck
which was insidious in onset , initially smaller in size .
Gradually progressive attain a current size
No H/O pain
No H/O sudden increase in size
No H/O breathlessness , difficulty in swallowing
, hoarseness of voice
No H/O Syncopal attacks
No H/O Indrawing of eyeball
No H/O ipsilateral loss of sweating
No H/O excessive sweating
No H/O loss of weight / weight gain
No H/O diarrhea / Constipation
No H/O oligomenorrhea/ menorrhagia
No H/O heat / cold intolerance
No H/O diplopia
No H/O tremor , Insomnia ,
No H/O Chest pain, Pedal edema , palpitations ,
breathlessness
NO H/O jaundice , bone pain , cough with hemoptysis
No H/O swelling elsewhere in the body
PAST HISTORY
No H/O similar complaints in the past
No H/O previous surgery
No H/O DM , HT , TB , Asthma , Epilepsy , Jaundice ,
No H/O irradiation
PERSONAL HISTORY
Consumes mixed diet
No H/O excessive iodine intake
No H/O excessive consumption of brassica group of
vegetables
Normal bowel and bladder habbits
Not a smoker / alcoholic
No H/O allergic to food & drugs
MENSTURAL HISTORY
Age at menarche : 15 years , regular cycle 3/30 , no
clots
LMP : 21 nov 2017
no pads soaking for a day : 2
FAMILY HISTORY
No relevant family history
GENERAL EXAMINATION
The patient is conscious , oriented , well built &
nourished
No pallor / icterus / cyanosis / no clubbing / no pedal
edema / generalised lymphadenopathy
No eye signs
no tremor
skin normal
No signs of hyper/hypothyroidsm
Vital signs
Pulse : 74/min , normal in rhythm , volume , no
specific character , no radio radial / radio femoral
delay , all peripheral pulse felt
Blood pressure : 110/70 mmHg measured in right
arm in sitting position
Respiratory rate : 16/min , thoraco abdominal type
Temperature : Afebrile
Examination of Thyroid region
After getting consent from the patient , explaining the
procedure , the patient was examined in sitting position
under bright light
INSPECTION :
A single swelling of size 4 * 4 cm , hemispherical in
shape present in the front of neck region of thyroid
extending from 3cm below from thyroid cartilage , 2cm
above from sternal end of clavicle , medically upto midline
, laterally along anterior border of sternoclenomastoid
muscle on right side
smooth surface
skin over the swellling normal
swelling moves with deglutination, does not
moves with protrusion of tongue
lower border is seen
trachea appears to be midline
no scars / sinus / visible pulsation / dilated
vein / no visible node enlargement
PALPATION
After asking the patient to slighty flex the neck ,
palpation is done standing behind the patient & then
from front
not warmth / non tender
inspectory finding of site , size , shape , extent
? confirmed
margins well defined
smooth surface , skin over swelling normal
firm in consistency , which is mobile
skin pinchable
plane of swelling deep to deep cervical facia
lower border is palpable
caratoid pulsation felt equally on both sides
Trachea is in midline
kocher's test ? no stridor
no palpable thrill
PERCUSSION
normal resonant over sternum
AUSCULATION
no bruit heard
Examination of lymph node :
No nodes are palpable
OTHER SYSTEM EXAMINATION
RS : Normal vesicular breath sounds heard , no
added sounds
CVS : S1 , S 2 heard , no murmur
Abdomen : soft , non tender , no organomegaly
CNS : no focal neurological deficit
Spine & Cranium : Normal
Diagnosis :
Non toxic Solitary nodule of thyroid involving
the right side in euthyroid state with no pressure
symptoms
MANAGEMENT
Investigation :
Routine investigation
complete hemogram : TC /DC/ ESR / Hb /
Blood grouping and typing
Blood sugar , urea , creatinine , serum
cholesterol
Urine sugar , albumin
X ray chest - PA view
ECG
Specific investigations
USG ? neck
Thyroid function test ? Free T3 ,Free T4 ,TSH
level
Fine needle aspiration cytology
X ray neck ? PA / Lateral view
CT neck
IDL
Radio-iodine uptake study
TREATMENT
Hemithyroidectomy of right lobe
This post was last modified on 08 August 2021