Short case

Patient Particulars
Name : ABC
Age : 35years
Sex : Female
Education : Illiterate
Occupation : house maker
Address : Yavatmal
Low Socioeconomic status
HISTORY OF PRESENTING ILLNESS
• Patient was apparently alright 8 years back then she noticed a
swelling in front of the lower neck while taking bath. It was
insidious in onset, gradually progressive ; Initially was about the
size of pea (2*2cm) and since 2 months it has progressed to
current size of a Orange (7*7cm) ; Not associated with pain.
• Complaints of noisy breathing since 1 month
• Complaints of Palpitation since 1 month on walking
CONTD..
• Complaints of easy fatigability since 1 month
• History of weight gain since 5 months (5 kg)
CONTD..
• No history of diplopia / change in glasses / blurring of vision
• No history of diarrhoea / constipation
• No history of chest pain / tachycardia / bradycardia
• No history of tremors
• No history of hair loss / pruritus
• No history of oligomenorrhea / menorrhagia
• No history of irritability / nervousness / insomnia
• No history of features of Hyperthyroidism or Hypothyroidism
• No history of bone pain
Pressure signs

• No history of dysphagia
• No history of ptosis or anhydrosis
Past history
• No history of Radiation therapy.
• Not a known case of Diabetes Mellitus / Hypertension / Epilepsy /
Asthma
Menstrual history
• Age at menarche - 13 years
30 days cycle
5 days flow
Obstetric history
• Married at 18 years ; Non consanguinous marriage.
• First child - male ; 17 years old
• Second child - female ; 15 years old
Family history
• No history of thyroid diseases in the family or locality
• No history of Cancers in family (MEN syndrome)
Personal history
• Diet – non vegetarian diet consumes high brassica containing diet.
• Consumes packaged salt
• Apetite - Normal
• Sleep – Disturbed
• Bowel and bladder – Normal and regular
• Habits - No habits of substance abuse
Treatment history

Medical
• History of over the counter antacids and analgesics.
• No History of usage of thyroid related medications.
• No History of contraceptive medications.
Surgical
• No history of any surgeries in the past, other than tubectomy.
Summary
• A 35 year old lady presented with OPD with the chief complaints of
swelling in the lower part of the neck since 8 years and gradually
increased in size since 1 month with NO suggestive features of
hypothyroidism or hyperthyroidism.
General physical examination

• Patient is made to sit in a well lighted room and oral consent was taken
for the examination
• Examination is done in presence of a female attendant
• Patient is conscious, cooperative and well oriented to time place and
person.
• Built – Moderate
• Nourishment (BMI)– 20kg/m², No overt signs of Nutritional deficiency.
• Mild pallor present
• No Icterus, Cyanosis, Clubbing, Lymphadenopathy and Edema
Vitals

• Respiratory rate – 18 cycles per minute, regular rhythm,

bilaterally symmetrical, thoraco- abdominal type.
• Pulse(right radial) – 70 beats per minute, regular rhythm, normal
in volume and character; condition of arterial wall normal, other
peripheral pulses were palpable and bilaterally symmetrical;
Collapsing pulse was absent
• Blood pressure – 130 / 80 mmHg, right arm supine position
• Temperature – 98°F
Head to toe examination
• Hair – black, lustrous
• Face – dull, facial flusing
• Eyes – Pallor present
No other eye signs are positive
• Skin - dry skin
• Spine - normal
• Limbs - normal
Local examination

Inspection
• There is a solitary swelling in the front of the lower neck measuring
about 5 cm horizontally and 7cm vertically extending longitudinally from
thyroid cartilage to about 5cm above suprasternal notch and horizontally
between anterior border of sternocleidomastoid muscle on both sides.
• PIZZILLO’s method – the swelling becomes more prominent.
• Surface appears smooth ; nodular swelling.
• Moves up with deglutition.
• Doesn’t move on protrusion of tongue
CONTD..
• Skin over the swelling is normal
• No scars, sinuses or engorged veins
• Trachea appears to be Central
• PEMBERTON‘s Sign – Negetive
(Neck veins do not become prominent on raising arms)
Palpation
• All inspectory findings are confirmed.
• No tenderness
• No local rise of temperature
• Surface - smooth, firm in consistency, solitary nodule
• Mobility - mobile in horizontal plane ; not vertically.
• Not reducible ; non compressible.
• Able to get below the swelling.
CONTD..

• CRILE‘S METHOD – nodularity felt at pulp of thumb that moves with

deglutition
• LAHEY’S METHOD – margins of both Lateral lobes felt
• KOCHER’S SIGN – Negetive
• BERRY’S SIGN – Negative
• Trachea is central
Auscultation
• No briut heard.
Lymph node examination
• No Enlargement of cervical of Supra cervical lymph nodes
Systemic examination
• Cardiovascular system – S1 AND S2 heard, no murmurs.
• Central nervous system – clinically normal
• Respiratory system – normal vesicular breath sounds heard
• Per abdomen – soft, non tender, no organomegaly
Provisional diagnosis
• Solitary non toxic thyroid nodule probably benign with euthyroid
status.
Differential diagnosis
• Solitary non toxic nodule
• Colloid Goitre
• Hashimoto’s thyroiditis
• Dominant nodule of multinodular goitre