CASE PRESENTATION ON

MULTINODULAR Goiter

BY
RIYA JOSE
5TH PHARM D
ROLL NO:20
 GOITER
A goiter is the irregular growth of the thyroid gland. The thyroid is a butterfly-shaped gland located at the base of the
neck just below the Adam's apple. A goiter may be an overall enlargement of the thyroid, or it may be the result of
irregular cell growth that forms one or more lumps (nodules) in the thyroid. A goiter may be associated with no change in
thyroid function or with an increase or decrease in thyroid hormones. Multinodular goiter (MNG) is the result of the
genetic heterogeneity of follicular cells and apparent acquisition of new cellular qualities that become inheritable.
Euthyroid: The state of having normal thyroid gland function

SIGNS AND SYMPTOMS :

• sudden and unexplained weight loss.

• rapid heartbeat.
• increased appetite.
• nervousness or anxiety.
• tremors, usually in your hands.
• sweating.
• increased sensitivity to heat.
PATIENT DEMOGRAPHICS

 PATIENT NAME : Deviramma

 AGE : 61yrs
 SEX : Female
 IP NO : 2202040183
 UNIT : MED 2
 DOA : 04/02/2022
SUBJECTIVE EVIDENCE
c/o solitary swelling present over neck since 5 month

PAST HISTORY
Recently diagnosed with T2DM on treatment
N/K/C/O Hyperthyroid or Hypothyroid
N/K/C/O HTN

OBJECTIVE EVIDENCE
CVS : S1,S2 +, no murmur Hb : 13.2 g/dL
RR : 16 cpm Na+ : 130.3
RS : B/L NVBS+ K+ : 4.01
CNS : conscious and oriented Cl- : 99.8
PR :78 bpm
P/A :soft , non tender
T3 : 1.60mg/dL
T4 : 10.06mg/dl
TSH : 0.78
RBS : 531 mg/dL
ASSESSMENT

DIAGNOSIS : Based on the subjective and objective evidence the patient was diagnosed with
multinodular goiter in euthyroid state

PLANNING

GOALS :
To improve the patient quality of life .
To prevent the further complication of disease.
To reduce the swelling of the patient
 MEDICATION CHART
DRUG GENERIC NAME DOSE FREQUE D1 D2 D3
NCY
Normal saline 100ml/hr √ √ √
Tab. PAN Pantoprazole 40mg 1-0-0 √ √ √
Cap. BECOSULES Thiamine 0-1-0 √ √
Inj.ACTRAPID Insulin 1 vial 8-8-8 √ √ √
Inj.LISPRO Insulin 100IU 10-0-10 √ √ √
Inj.ZORENSIA Cefoperazone 1.5 g 1-0-1 √ √ √
Inj.TRAMADOL Tramadol 50mg in SOS √ √
100ml
Inj. EMESET Ondasetron 4 mg SOS √ √ √
Inj.SUMOL Acetaminophen 1g 1-1-1 √ √
Inj.GENTAMICIN Gentamicin 80mg 1-0-1 √ √ √

Surgery done on day 2

INTERACTION
TRAMADOL+ONDASETRON : Concurrent use of Tramadol and Serotonergic Agents may
result in increased risk of serotonin syndrome

INTERVENCTION
Two short acting insulins are given to the patient simultaneously

STAT insulin was not given for newly diagnosed high hyperglycemic
patient
DISCHARGE
DRUGS DOSE FREQUENCY
Tab. Pan 40mg 1-0-1
Tab. Tramadol 100mg 1-0-1
Tab. Gentamicin 80mg 1-0-1
Tab Rocaltrol 0.25 mcg 1-1-1
 PATIENT COUNSELLING
DISEASE RELATED
 A multinodular goiter is a goiter where there are many lumps (nodules) that appear within the gland.
 Euthyroid state is the state of having normal thyroid gland function.

DRUG RELATED
• Tab.Pan D should be used 30 mins before food to inhibit any gastric irritation.
• Tab Tramadol should be taken after food and don’t take more than what doctor prescribed
• Cap Becosules can cause side effect such as flushing, hives, itching, sweating, nausea, restlessness
• Inj. Actrapid , the label should be checked to make sure it is the right type of insulin,remove the
protective cap. Always use a new needle for each injection to prevent contamination.
• Inj.Insulatard may cause hypoglycemia which may show symptoms such as cold sweat, cool pale skin,
headache, rapid heartbeat, feeling sick, feeling very hungry, temporary changes in vision, drowsiness,
unusual tiredness and weakness, nervousness or tremor, feeling anxious, feeling confused, difficulty in
concentrating.
• Inj. Zorensia should be taken continuously without any skipping of doses
• Inj. Emeset should be taken in the dose and duration as advised by your doctor. Swallow it as a
whole. Do not chew, crush or break it. Emeset 4 Tablet may be taken with or without food, but it is
better to take it at a fixed time.
• Inj. Gentamicin should be used continuously without any skipping.
 LIFESTYLE MODIFICATIONS
• Always use a new needle for each injection to prevent contamination.
• Needles and syringes must not be shared.
• Dairy products like yogurt, ice cream, and milk contain iodine. The thyroid needs iodine to prevent its glands from
becoming enlarged . Eggs contain healthy amounts of both selenium and iodine.
• Fish is rich in Omega-3 fatty acids and selenium, which both help decrease inflammation.
• Take an adequate amount of sleep and avoid stress as they lead to overeating and unhealthy food choices.
• Limit your intake of processed food and drink lots of water.
• It is important to consume iodine when trying to lose weight, but restrict processed salt intake and opt for natural
sources of iodine.
• Weight gain is one of the symptoms of thyroid disorders, so exercising regularly is really important