ROJoson Patient-Centered Study: THYROID - OTP23dec18

1. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
A patient-centered study is an in-depth, detailed review and
evaluation of management done to a particular patient within the
context of patient-centered care principles.

2. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
OTP, a 58-year-old female, OFW in Hong Kong, messaged me in
Facebook Messenger in November 29, 2023. She said she would be
coming to the Philippines in December 2023 to have her thyroid
operation done by me. I previously operated on her soft tissue
sarcoma on the back 11 years ago with no signs of recurrence up to
now. She was happy with my service that she wanted me to be the
one to operate on her thyroid nodule.
History showed she noted the thyroid nodule 6 months prior to
consulting physicians in Hong Kong. She was initially seen in Queen
Mary Hospital in Hong Kong in November 11, 2023 and was scheduled
to have a thyroid operation on June 7, 2024. She and her employer
deemed it wise for her to go to the Philippines for her thyroid
operation. She was given a month-leave by her employer.

3. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
She had a telemedical consultation with me and on video chat, I
discerned she had a goiter. She did not have an ultrasound of the
thyroid done. The clinician in Hong Kong reported a 6x5 cm firm left
thyroid nodule. I did not see a record from the Hong Kong clinician on
the diagnosis. She was just advised and scheduled for a thyroid
operation on June 7, 2024.

4. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
My primary diagnosis after the telemedical consultation was a colloid
adenomatous nodule, left lobe. My bases: no neck nodes; 80/min
pulse rate; and then, based on prevalence (most common cause of
goiter).
I gave her the options of trial of medical therapy and operation. She
chose operation.
I then accommodated her to an arrangement of an operation as soon
as possible and within the time limit given to her by her employer. I
did the booking at the operating room; asked somebody to assist her
in the room reservation; etc.

5. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
She arrived in the Philippines at 2 am on December 15, 2023. She
went directly to the hospital for admission.
The next day, December 16, 2023, I operated on her.
Prior to the operation, I did an evaluation and my preoperative
diagnosis was a colloid adenomatous nodule on the left lobe.

6. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
I planned out my incision – less than 2 inches over a skin crease on the
lower part of the neck, more to the left of midline, overlying the
palpable mass, and about one (1) cm crossing the midline (red line) to
the right side.
Preoperative and postoperative illustrations of incision shown below:

7. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
Intraoperative findings showed the following:
• grossly normal right thyroid lobe
• left thyroid lobe with a 4 to 5 cm cystic mass on the lower pole (on
opening the cyst after skin closure, cloudy fluid exuded out, about 5
cc, and there were adenomatous areas on the inner lining of the
thick capsule of the cyst).

8. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
Operation done:
Total lobectomy, left; isthmectomy; pyramidalectomy
I made sure to preserve the parathyroids on the left and not to injure
the left recurrent laryngeal nerve.
Operating Time: around one hour

9. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
Postoperative Course:
No complications such as bleeding, hoarseness of voice, hypocalcemia,
etc. No antibiotics prescribed just pain medications.
She was discharged the next day after the operation but she opted to
stay for another day as she will travel to her home province.
She just took mefenamic acid for postoperative pain (about two
tablets only).

10. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
She was advised to wash her wound with soap and water twice a day
and not to put gauze and plaster anymore to cover the wound.
There is a risk for blisters and wound irritation with use of plaster.
She was advised to place a scarf around her neck when she travels, like
the one illustrated below.

11. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
Final diagnosis: Colloid adenomatous nodule, left lobe
She does not need postoperative thyroid hormonal medication for
replacement as she is not in hypothyroidism after the operation.
Surveillance using symptom and sign approach is advised.
She can go back to Hong Kong on January 15, 2024.

12. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
Hospital Expenses for the Thyroidectomy
Total amount of hospital expenses without the professional fees:
~P7,000.00
P25,000.00 – P18,600.00 (PhilHealth) = ~P7,000.00
She was not able to secure a PWD card which she is entitled to
because of her history of back cancer. If she had, her hospital
expenses would just be ~P2,000.00

13. ROJoson Patient-centered Study
Concern: THYROID MASS
OTP, 58/F, 2023dec
Delightful Patient Experience as expressed by patient