Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Thyrotoxicosis Clinical Examination Discussion and Treatment
AGE: 35 YRS
SEX: FEMALE
OCCUPATION: HOME MAKER
ADDRESS: KORUKKUPET
CHIEF COMPLAINTS
PROMINENT EYES for past 1yr
HISTORY OF PRESENTING
ILLNESS
The patient was apparently normal 1 yr back
after that she noticed prominent eyes.
Associated with increased dryness.
No h/o itching,redness of eyes or blurred
vision.
No h/o diplopia
H/O loss of weight (15 kgs in one yr)
No h/o loss of appetite
H/o intolerance to heat
H/o excessive sweating
? H/o anxiousness and nervousness
? H/O tremors
? H/o diarrhea on and off episodes, 2-3
times a day, semisolid stools, not blood
stained , no mucus, no passage of
worms, not fowl smelling.
? No h/o vomiting
? H/o muscle weakness ?difficulty in
climbing up stairs.
? H/O palpitations
? No h/o any swelling
? No h/o fever
No History suggestive of pressure symptoms
like
No h/o dyspnoea
No h/o dysphagia
No h/o change in voice
No h/o suggestive of Horner's syndrome
No h/o syncope
No History suggesstive of hypothyroidism like
No h/o weight gain inspite of poor appetite
No h/o constipation
No h/o cold intolerance
No h/o easy fatiguability
? NO h/o sudden increase in size
No history suggestive of malignancy like:
? 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
PAST HISTORY
No h/o similar complaints in the past
No h/o previous hospitalisation
Not a known case of diabetes , hypertension,
asthma , epilepsy, tuberculosis, jaundice ,
ischaemic heart disease
No h/o irradiation
No h/o previous surgery
No h/o drug intake
PERSONAL HISTORY
Non ? vegetarian diet
Patient consumes adequate salt
No h/o excessive intake of goitrogens
H/o altered bowel habits: diarrhea on and
off episodes
No h/o altered sleep pattern
MENSTRUAL HISTORY
Attained menarche at 15yrs of age
Irregular cycles for the past 2 yrs, 4/70
days, less flow, not associated with clots
or dysmennorhea
Last menstrual period:17-10-2017
FAMILY HISTORY
No history of similar complaints in the family
ALLERGIC HISTORY
No significant allergic history
Summary :
35 year old female, came with the
complaints of prominent eyes for the past
one year, palpitations, nervousness,
weight loss inspite of good appetite,
diarrhea, oligomennorhea probably
involving pathology of thyroid gland.
GENERAL EXAMINATION
Conscious, oriented
Moderately built and nourished
No pallor
Not icteric
No cyanosis
No clubbing
No pedal edema
No peripheral significant lymphadenopathy
EYE SIGNS
Eyeballs are prominent
Dalrymple sign: upper sclera is seen above
the limbus
Stellwag sign: infrequent blinking of eyelids
Von graefe sign: lid lags behind on asking
to look up and down
Enroth sign: oedema of eyelids and
conjunctiva
Gifflord sign: difficulty in everting upper
eyelid
Intention tremors present
Hands are warm and moist
No pretibial myxoedema, pruritis, palmar
erythema, thinning of hair, dupuytren's
contracture.
No corneal conjunctival ulcers.
VITAL SIGNS
BP: 130/80mm Hg measured in left
upper limb in sitting posture.
Respiratory rate: 17/min
thoracoabdominal
Pulse rate: 102/min regular in rhythm,
normal in volume, no specific character,
no radio-radial and no radiofemoral
delay,no vessel wall thickening, felt in all
accessible peripheral vessels.
Temperature:980 F (afebrile)
LOCAL EXAMINATION OF THE NECK
After getting consent from the patient and explaining
her the procedure the patient is examined
Examination in the front of neck in the region of
thyroid
INSPECTION
No visible enlargement in the thyroid region
No visible nodules
Surface appears to be smooth
Skin over the region of thyroid normal
No scar , no sinus, no dilated veins
No visible pulsations
Trachea appears to be in midline
PALPATION
Warm, not tender
Mild diffuse enlargement of thyroid gland
Smooth surface
No nodules
Soft in consistency
Moves up on deglutition
Does not move with protrusion of tongue
Lower border palpable
Becomes more prominent on performing
pizzilo method
Plane of the swelling : deep to deep fascia
Carotid pulsation felt against the upper border
of thyroid cartilage equal intensity on both
sides(Berry's sign negative)
No palpable thrill
Trachea is in midline
No other swellings present
Kocher's test: no stridor
PERCUSSION
No retrosternal dullness
AUSCULTATION
No bruit heard
EXAMINATION OF LYMPH NODES
No palpable lymph nodes in the neck
region.
OTHER SYSTEM EXAMINATION:
RS: Normal vesicular breath sounds
heard, no added sounds
CVS: S1 , S2 heard, no murmur
CNS : No focal neurological deficit
Abdomen :soft, non tender, no
organomegaly, no free fluid, hernia
orifices free.
Spine and cranium normal.
DIAGNOSIS
A Case of primary
thyrotoxicosis
INVESTIGATION
Baseline investigations : CBC, TC, DC,
Hb%,ESR, BT,CT
Blood urea, serum creatinine
Urine :sugar ,albumin
Chest x-ray
ECG
LFT, RFT
Specific investigations
? Thyroid profile:TSH,T3,T4,FREE
T3, FREE T4
? USG neck
? X-ray neck
? Sleeping pulse rate
? fine needle aspiration cytology.
? laryngoscopy
? Thyroid stimulating Autoantibodies
? Radio active iodine uptake
TREATMENT
TOTAL THYROIDECTOMY
This post was last modified on 08 August 2021