CASE PRESENTATION

A 52 year old female,who’s a homemaker, hailing from cheyyar presented with

chief c/o
- swelling infront of neck for 2 years
- loose stools for 2 years

History of presenting illness

- swelling in front of neck on R side for
- 2 years of duration
- insidious onset
- gradually increased in size to reach the current size
- no specific aggravating or relieving factors
- no history of pain
-No h/0 pressure effects
- No H/o breathing difficulty
- No H/o dysphagia
- No H/o hoarsness of voice
- No H/o abdominal pain/distention
- No H/o excessive sweating
- No H/o malena hematochezia
- H/o loose stools + ( chronic diarrhoea)
- since 2 years
- multiple episodes per day
- no specific aggravating/relieving factor
- No H/o tremors/insomnia/palpitation/ heat or cold intolerance/ weight gain or loss
- no h/o suggestive of metastasis
Past history
- k/c/o Hypothyroidism, on regular treatment ( T.Thyroxine 25 microgram
OD) since 7yrs
- Not a k/c/o SHTN/PTB/T2DM/BA/CAD/CKD
- No H/o any drug allergy
- H/o PS done – 28 years back
- No H/o irradiation
Personal history
- Mixed diet
- Bowel habits altered
- Bladder habits - normal
- Sleep and appetite - normal
Menstrual and Marital history
- Attained menarche at 12 years of age
- had RMP with 4/30 cycles
- Attained menopause 3 years back
- P2L2 both NVD
- Sterilised 28 years back after 2nd delivery

Family history
- not relevant
GENERAL EXAMINATION
O/E
- patient was thin built ,moderately nourished
- patient conscious, oriented, afebrile, hydration fair
- No pallor, icterus, clubbing, cyanosis, pedal edema
- No e/o any eye signs
- karnofsky performance status =90

S/E
- CVS : S1, S2 + PR=78/min
- RS : BAE + BP=118/72 mm of hg
- P/A : Soft BS + SPO2=98%
No guarding/rigidity TEMP=Normal
- CNS : B/L PERL
NFND
LOCAL EXAMINATION (NECK)
Inspection
- 6*5 cm irregular swelling infront of neck on R side, that moves with
deglutination
- surface : smooth
- No scars/ sinuses/ dilated veins
- lower border visible, just above right medial end of clavicle
- laterally extends upto lateral border of sternomastoid,whereas medially just
crosses the midline
- non pulsatile
Palpation
- Not warm/ tender
- 6*5 cm irregular swelling infront of neckon R side
- moves with deglutition
- surface - bosselated borders well defined
- inspectory findings confirmed
- cystic to firm in consistency with multiple nodules palpable over the swelling
- carotid artery pulsation felt on both sides.
- trachea deviated to left side
- kochers test negative
- non pulsatile
Auscultation
no bruit heard
Auscultation
- no bruit heard

Diagnosis
A case of multi nodular goitre, clinically euthyroid with thyroxine supplementation
probably of benign etiology