THYROID SWELLING

1. CASE
PRESENTATION
Dr. AZAD MEENA
JRA 2ND Yr

2. Case presentation
• Name – Manju devi
• Age – 40year
• Sex – female
• Religion - hindu
• Occupation – housewife
• Residence – motihari, patna
• D/O PRESENTATION 22 sept 2020
• D/o examination – 04 OCT 2020

3. • Chief complain –
midline neck swelling since 1 year
fever on/off since 1 year
pain on/off since 1 year

4. History of present illness
• Patient was apparently well 1 year back when
she noticed midline neck swelling more on
right side aroud 1cm x 1cm. Which was
insidious in onset progressively increasing in
size to the present size of around 3cm x 4cm .
Patient also have complain of low grade
fever(3-4times) and pain which was relieved
by medication but swelling was gradually
increasing in size.

5. • No h/o rapid increase in size
• No h/o difficulty in swallowing and change in voice
• No h/o hemoptysis / hematemesis/jaundice
• No h/o loss of weight and gain of weight
• No h/o hot/cold intolerance
• No h/o irritability/insomnia/excitability/tremer
• No h/o palpitation
• No h/o bowel and bladder disturbance
• No h/o protrusion of eye
• No h/o any other swelling in the neck and body
• No h/o appetite loss
• no h/o TB/ contact with TB patient

6. PAST HISTORY
• Pt. Have history of hysterectomy 3 year back
in a private hospital with the c/o heavy vaginal
bleeding since 2 yr.(documents not available)
• No h/o any medication
• No h/o similar complains in the past
• No h/o radiation exposure

7. FAMILY HISTORY
• No h/o similar illness in family
• No h/o any malignancy
• No h/o DM/ASTHMA/TB/HTN

8. Obstetric and Menstrual history
• Pt is married and mother of four child
• LMP- 3 yr back before hysterectomy
• No h/o abortion
• Now amenorrhic since 3yrs

9. Personal history
• Pt is on mixed diet
• Appetite is normal
• Sleep is normal
• Bowel and bladder habits normal
• Not addicted to any substance

10. summary
• A 40 yr female presented with swelling in the
midline neck, gradually increasing in size over
past 1 year without symptoms of
hypothyroidism /hyperthyroidism and no local
pressure symptoms

11. General physical examination
• Pt is cooperative concious and well oriented to time ,
place and person
• Examination done in sitting position
• Moderately built
• She is well hydrated and moderately nourished
• Vital :-
Blood pressure – 130/80mmHg in right arm in supine
position
Pulse rate - 80bpm regular, normal volume and
character.
Respiratory rate – 16/min abdominothorasic type
Temperature - ???

12. • No pallar, icterus, clubbing, pedal oedema,
palpable lymph node and cynosis

13. Local Examination
• Pt was examined in sitting position with verbal
consent of patient in the presence of
attendant.

14. On Inspection
• Inspection is done by following Pizillo`s method.
• A single spherical swelling seen in lower midline
neck more on right side looks around 3cm x 4cm in
size. It moves with deglutition. Edge of swelling is
indistinct.
• Non pulsatile.
• Moves with tongue protrusion.
• No distended vein seen over swelling.
• The Lower border is visible on deglutition.
• skin over swelling apears normal

15. On Palpation
• The swelling is palpated from behind with the neck
slightly flexed
• There is no local rise in temperature
• No tenderness
• A single swelling is palpable in the midline 3cm x 4cm
in size.
• Extend behind the anterior border of
sternocleidomastoid on right side
• Smooth surface.
• Well defined margin.
• Uniform and soft consistency
• Swelling is movable in both horizontal and vertical
direction.

16. • Normal position of trachea.
• Translucency negative
• no impulse on coughing
• Nonreducible
• Overlying skin is movable
• Dissapear on contraction of sternocleidomastoid
muscle
• cervical lymph node is not palpable.

17. Percussion
• Not done
• Auscultation
• No bruit heard

18. Systemic examination
• CVS-S1S2 Heard, no added murmur
• RS – B/L chest expansion equal with B/L
normal vesicular breath sounds. No added
sound
• P/A – soft, no distension, no evidence of
organomegaly or free fluid, bowel sound
present

19. Provisional diagnosis
• Right side nontoxic benign thyroid nodule
• Differential diagnosis
• Colloidal goitre
• Nontoxic Solitory nodule
• Follicular adenoma
• Enlarged Pre tracheal lymph node
• Thyroglossal cyst
• Simple/haemorrhagic cyst
Benign neoplasm

20. PLAN
1. Routine blood investigation
2. Thyroid function test
3. Ultrasound neck
4. FNAC neck