Solitary Thyroid Nodule -Harsh Da.ppt
- 1. Dr Harsh Agarwal ,JR3(Department of General Surgery ,RKMSP) Case Presentation on Solitary Thyroid Nodule
- 2. History Mrs ‘M’ , 38 year old , homemaker , hindu , from Kolkata belonging to middle class family presented with chief complaint of • Swelling in front of neck from last 3 years
- 3. History of Present illness • Insidious onset of a single swelling • Slowly but gradually increasing in size from small to large current size where it can’t be fully gripped by her finger like before . • Painless • No complaints of any other swelling in neck • No complaints of difficulty in breathing or eating • No change of voice or hoarseness
- 4. • No history suggestive of hypothyroidism and primary or secondary thyrotoxicosis • No history suggestive of distant metastasis • No history suggestive of any syndromic manifestations • Known Case of Diabetes Mellitus
- 5. • No History of childhood radiation exposure • No History of food or drug allergy • History of Ayurvedic and homeopathic treatment present • No history of previous neck surgery Past History
- 6. Surgical History • History of Multiple Surgical interventions present 1. 2016 - TAHBSO for Uterine Fibroids 2. 2006 - Open Right Inguinal Hernioplasty 3. 2000 & 2002 - LSCS 4. 1998 - Open Appendicectomy
- 7. Drug History • Patient is on Sitagliptin 50mg and metformin 500mg from last 5 years and Injection Lantus 10 units from last 3 years • No history of intake of levothyroxine and anti-thyroidal drugs
- 8. Personal History • Normal sleep, appetite ,bowel and bladder habits • No history of any kind of drug abuse or addictions • On Regular Non- Vegetarian Bengali Diet
- 9. Family History • Patient lives with her two sons and husband , all enjoying good health . • No history of similar neck swelling or any known thyroid related disease in first degree relatives • No history suggestive of any cancer syndromes like MEN II syndrome related diseases in her family
- 10. To Summarize • 38 year old woman presenting with a gradually progressive swelling in front of neck from last 3 years, with no history suggestive of hyper or hypothyroidism , and no history suggestive of metastasis , no significant family history and no radiation exposure.
- 11. General Examination • Conscious , Oriented to time , place and person • Well Built and Performance status - 90 by karnofsky score ,BMI - 25.7 (Overweight) • Facies - Normal • Skin - Normal • Well Hydrated • No Generalised Lymphadenopathy • No Pallor , icterus , cyanosis , clubbing • No pitting or Non pitting edema • Pulse - 76/min , regular , normal volume and no special character • BP- 120/80 mmHg in supine right arm • Temperature - 98.2 F oral
- 12. Local examination Inspection • A distinct asymmetrical swelling noted in right lower neck region approaching the midline medially and sternocleidomastoid muscle laterally and above the sternoclavicular joint . • Globular in shape • 4 x 4 cm in size • Edges not well demarcated • Move Up with swallowing but not on protrusion of tongue • No scar ,no venous engorgement • Pemberton Sign Negative
- 14. Palpation • No rise of temperature , non - tender • A single Globular swelling of 4 x 4 cm size noted on right of midline • Lower border of swelling palpable above suprasternal notch and also on deglutition • Surface is smooth with Well defined margins • Firm consistency • Not fixed to the skin • Lateral mobility of swelling is not restricted • No Cervical Lymphadenopathy separately palpable from the swelling
- 15. • Trachea slightly deviated to left side • Berry’s sign negative • Kocher’s sign negative • On Percussion - Resonant note over sternum present • On Auscultation - No bruit heard • No Signs of Thyrotoxicosis present • On Systemic Examination • Per Abdomen ( Multiple linear scars noted , no organomegaly ) , Cardiovascular examination , Respiratory system and Nervous system examination were unremarkable. • Spine examination - no tenderness
- 16. To Summarize .. • 38 Year old lady with a history of a discrete swelling in right side of front of neck gradually increasing in size since last 3 years , which is painless , with no history suggestive of any of the following -compressive features , Hypothyroidism , hyperthyroidism or metastatic disease and a known case of diabetes mellitus and no significant family history . • On Examination , a swelling , right of midline of lower neck , 4 x 4 cm which moves with deglutition , with no other palpable swelling in neck , with no retrosternal extension, with no signs of thyrotoxicosis .
- 17. Provisional Diagnosis • 38 year old lady , with Solitary Thyroid Nodule , clinically Euthyroid probably benign with no compressive symptoms and no metastatic features and a known case of Diabetes Mellitus .