Thyroid case discussion

DR.SHAHZAEB
RESIDENT SURGEON
SURGICAL UNIT 1
CASE DISCUSSION.

HISTORY
A 45 years old lady HUSNA w/o AMEER
BUX, r/o Nawabshah, muslim, married
and housewife came here via OPD on
date 10-02-2020 admitted in Surgical unit
1 on bed 52 with compliants of:
 Swelling on Left side of Neck for 2
years
 Pain in swelling for 3 months

HOPC.
According to my patient, she was in usual state of health then she
developed swelling that has duration of two years, it started
spontaneously on left side of neck lateral to midline and noticed by
herself casually. Swelling was progressive, initially it was about pea
size latter on gradually increased up to a lemon. Neither it was
associated with pain, fever, secondary changes nor she she has the
history of trauma and firearm.
There was not any history of other swelling and weight loss. Swelling
was associated with dyspnea for one year. Dyspnea was exertional
having no history of orthopnea and PND. It remained continuous for
whole day with no changes in severity. Dyspnea was associated with
productive cough. Swelling was not associated with dysphagia and
hoarseness.

HOPC contd:
Pain started on the site of swelling, it has sudden onset with
duration of three months. Pain fluctuated with time, mild to
moderate in intensity and aching pain of character. Pain was
localized at site of lump. It was neither shifted, radiated nor
referred. Aggravating factors are taking food and relieving
factors are medications. It was not associated with sweating,
nausea, vomiting, palpitations and fever.
Patient has history of heat intolerance as well as increased
appetite while she has no weight loss, palpitations history and
bowel habits were normal.

Systemic Inquiry:
 CNS : Not Significant
 CVS : Not significant
 RESPIRATORY : DYSPNEA
 ABDOMINAL : NOT SIGNIFICANT
 URINARY : NOT SIGNIFICANT
 LOCOMOTOR : NOT SIGNIFICANT

PAST HISTORY:
 She was operated 12 years back for
hysterectomy
 She is known case of HYPERTENSION
diagnosed three months back

 Family history : Not significant
 Drug history: She is taking antihypertensives for
3 months.
Personal & socioeconomic history :
She has no any addiction.
She lives in muddy house, drinks water
from handpump. Sanitation is not
satisfactory.

General Physical Examination:
 An old lady with average
height and built, active,
conscious and well oriented
having no any deformity
sitting on the bed
comfortably with vitals
 B.P: 130/70
 Pulse: 88, Regular and normal
volume, No radio radial and
 radio femoral delay.
 R.R : 18
 Temp: A febrile
 Anaemia : Neg
 Jaundice: Neg
 Cyanosis: Neg
 Koilonychia: Neg
 Clubbing: Neg
 Dehydration: Neg
 Edema: Neg
 No lymphadenopathy.

Local Examination Of Neck:
 On inspection, swelling was present on left side of neck
lateral to midline, it was movable on deglutition while
tongue protrusion test was negative. Size was about 4 x 5
cms, shape seems to be spherical, surface was smooth,
skin over the swelling was normal has no any scar,
pulsations, sinus and dilated veins. Borders seems to be ill
defined. There was only one swelling.
 Pemberton sign was negative.
 Eye signs were negative ( No lid lag, Lid retraction and
Exophthalmoses).
 Tremors and pretibial myxedema were not visible.

 On palpation, temperature was normal, trachea centrally
placed, tenderness was positive. There was one single swelling
present on left side of neck lateral to midline that was movable
on deglutition. Swelling was 4x5cm horizontally and
vertically. Shape was irregular, surface was nodular, borders
were well defined, consistency was firm while the rest of
gland was not palpable. It was extended from medial border of
left sternocleidomastiod muscle to the midline of neck and
inferiorly 2cms above to suprasternal notch. Swelling was not
fixed to overlying structures as skin pinchbility was positive .
Swelling was partially movable in both horizontal and vertical
directions. Lower limit was palpable as I can get below the
thyrio
 Berry’sign was negative, kochers test was negative.
 Draining cervical lymph nodes were not palpable.

 Percussion: Normal
 Auscultation: No systolic bruit

SYSTEMICEXAMINATION:
 CNS: GCS 15/15, No atrophy, Tone was normal, Power 6/6 in all
limbs, Reflexes were intact.
 CVS: Apex beat in 5th ICS, No parasternal heave, S1 S2 audible
normally with no added sounds.
 ABDOMEN: Slight distended, Umbilicus centrally placed, No
tenderness on palpation, no visceromegaly, No fluid thrill or shifting
dullness and bowel sounds normally heard.
 RESPIRATION: No chest deformity, Trachea centrally placed, No
tenderness, Resonant note on both sides of chest. Normal vesicular
breathing with crepts.

Differential diagnosis:
 Solitary Nodular goiter
 Follicular Adenoma/Carcinoma
 Chronic Lymphocytic thyroditis

Investigations:
 Baseline investigations
( CBC,Viral Markers, Blood Sugar,
Urea&Creatnine, PT APTT).
 Chest XRAY
 Thyroid Function test
 Thyroid scan
 FNAC

Provisional Diagnosis.
 NonToxic Nodular Goitre .

Surgery.
 Left Lobectomy and isthumectomy.
Left lobe of thyroid gland and isthmus has
removed and tissue sent for histopathology.

Thyroid case discussion

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