Carcinoma Thyroid

Debarghya Mukherjee
History
• Patient particulars:
• Name-ABC
• Age-45 yrs old Gentleman
• Sex- Male
• Religion- Hindu
• Occupation- Engineer @ NPCIL
• Address- Tarapur
Chief complaint
• Swelling in front & side of neck since 7months
• Pain over the swelling since last 1 month
• Hoarseness of voice for since 1 month
• Difficulty in breathing for since 1 month
 History of present illness
My patient was apparently alright 7 months back. To start with he
developed,

• Swelling in front & side of neck

• Onset: insidious
• Initially very small in size not associated with pain & gradually
increasing in size.
• Since last 1 month he complained of pain along with rapid increase in
size of swelling which was dull aching in character, non radiating , not
associated with aggravating factors & relieved on medication.
• Pressure Symptoms :
• Difficulty in breathing since 1 month which increase on lying down
supine
• Not associated with dysphagia
• Hoarseness of voice since 1 month
• No associated wt loss or wt gain
• No palpitation or tremor
• No bulging of eyeball or double vision
• No insomnia, palpitation or ectopic beat
• No altered intolerance to cold or heat
 Past history

• No history of head & neck irradiation.

• No history of other concurrent medical illness(Asthma, Diabetes,
Hypertension, Tb)
Personal History
• Normal mixed indian diet including cabbage.
• No addiction history(smoking, tobacco, Alcohol).
• Disturbed sleep beacuse of dyspnea on lying down.
• Normal bowel and bladder habit
Family history

• No history suggestive of thyroid/head &

neck/breast/colon or any other malignancy.
 Summary

• 45 yrs gentleman presented with swelling in the neck for

last 7months associated with pain and hoarseness of voice
& dyspnea for last 1 month along with rapid growth in size
with no history suggestive of hypo or hyperthyroidism with
no significant family history and no radiation exposure.
 General examination
• The patient has given written consent for both general and local
examination under appropriate light which was done in presence of
attendent.
• Conscious, cooperative and well oriented to time, place and person.
• Well built , BMI:24 kg/m2
• Vitals:
• Temperature-99 degree F
• Pulse-80 bpm, regular in rhythm, good volume and character, measured
in right radial artery
• RR- 15/ min
• BP- 118/76 mm Hg., rt arm supine
• Pallor, icterus, clubbing, cyanosis, edema absent.
 Local examination
The patient was requested to remove his shirt and examination
was done in sitting position
• On Inspection:
• Swelling in front and sides of the neck
• Extending laterally upto sternocleidomastoid,superiorly up to thyroid cartilage and
inferiorly going behind the sternum
• Nodular surface
• Slight mobility with deglutition
• No skin changes/scar/sinus/fistula
• No engorged vein
• No pulsation seen
Local examination
• Palpation:
• Local temperature not raised
• Non tender
• Multi nodular swelling present in front and side of neck
• Right lobe- 7x5cm, left lobe- 4x3cm & isthumus - 3x2cm
• Moves slightly with deglutition
• Illdefined margins
• Variegated consistency
• Extending into retrosternal space
• Right sided carotid pushed slightly posteriorly
• Trachea is central in position
• No palpable thrill
• Kocher’s test positive
• Pemberton sign positive, presence of facial congestion
• Bilateral lymph node palpable in level 3- right:
1.5x1.5cm,left: 3x3cm.The lymph node are firm in
consistency and are mobile.
Percussion
• On percussion over manubri sterni a dull sound is heard.
Auscultation
• No systolic bruit heard.
• Examination of other system:
• CNS- Higher mental functions- N
• Sensory and motor function-Intact
• CVS-S1&S.2 heared normally no murmur
• GI-Abdomen soft & no organomegally
• Musculoskeletal system-Skull & Spine normal,No bony
deformities
Summary
• 45 yrs old gentleman presented with swelling in
front & both sides of neck for last 7 months
associated with pain and hoarseness of voice&
dyspnea for last 1 month along with rapid growth in
size with no history suggestive of hypo or
hyperthyroidism with no significant family history .
• On examination 10x7 cm multinodular swelling with
varigated consistency, ill defined margins with
bilateral level 3 lymphadenopathy.
 Provisional Diagnosis

• 45 year old gentleman with multinodular

thyroid swelling clinically euthyroid with
cervical lymphadenopathy with pressure
symptoms probably malignant.
DIFFERENTIAL DIAGNOSIS
• Papillary thyroid carcinoma
• Follicular carcinoma
• Anaplastic carcinoma
• Simple multinodular goitre
• Riedel’s thyroiditis.