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
![](44f94410-6573-4185-9b9f-859269cb268b-10_1.jpg)
lower border is seen
trachea appears to be midline
no scars / sinus / visible pulsation / dilated
vein / no visible node enlargement
![](44f94410-6573-4185-9b9f-859269cb268b-11_1.jpg)
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