Thyroid solitary nodule

1. Case
presentation

2. • Name – Mrs XYZ
• AGE -40YRS
• GENDER – FEMALE
• ADDRESS- HYD
• OCCUPATION- HOUSE WIFE

3. Chief Complaint
• Swelling in front part of neck -5 years

4. History of present illness
• Patient was apparently asymptomatic 5 yrs back then she noticed a swelling in front
part of the neck which was insidious in onset, gradually progressive and attained the
present size of around 5× 5 cm.
• Not associated with pain or fever.
• No history of sudden increase in the size of the swelling.
• No history of skin changes overlying the swelling.

5. • No history of other swellings in the neck.
• No history of difficulty in swallowing ,respiratory distress and change in voice

6. • No history of palpitations,loss of sleep, excitibility, irritabilty, appetite increase,
diarrhoea, heat intolerance, hyperactivity, hair loss.
• No history of increased fatiguability, weight gain, constipation, cold intolerance or
mood changes.
• No history of loss of weight, evening rise of temperature, cough with expectoration
• No history of bone pain, cough with hemoptysys , focal neurological deficits.

7. Past History
• Not a known case of HTN DM TB Asthma epilepsy
• No history of previous surgery
• No history of irradiation to the neck in past.

8. • Mixed diet
• Bowel and bladder habits normal.
• Sleep and appetite normal.
• Non smoker and non alcoholic
Personal history

9. Menstrual History
• Age of menarche 13yrs
Regular cyles 5/28days

10. Family history
• No history of thyroid related disease in family.
• No history of thyroid malignancy in the family .

11. • A 40 yr old lady, has come with a painless, progressive swelling of size 5×5 cm over
front part of neck without hypo or hyperthyroid symptoms, pressure symptoms and
features of metastasis.

12. General Physical Examination
• I have examined the patient with informed consent in a well lit room and adequate
exposure in the presence of family attendant.
• Patient is conscious, coherent, cooperative moderately built and nourished
• BMI - 20
• Hydration status – Well maintained
• Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy / Pedal Edema
absent

13. Examination of Neck
• Inspection
• An single oval shaped swelling of size 5×5 cm present in left lobe of thyroid with
horizontal extent -from the midline to 2 cm laterally on the left side, vertical extent –
2 cm below the thyroid prominence to 3 cm above the supra-sternal notch.

14. • The swelling is having well defined margins in all boundaries
• The surface of the swelling appears smooth
• No engorged veins / visible pulsations over the swelling or in the neck.
• Skin over the swelling normal.
• Swelling moves with deglutition but not with protrusion of tongue
• Lower border of the swelling is seen
• No any other swelling noted in the neck.

15. Palpation
• No local rise of temperature or tenderness overlying the swelling
• All inspectory findings are confirmed .
• The swelling is firm in consistency, mobile
• Plane of the swelling is deep to deep fascia and is not fixed to underlying structures
and overlying skin.

16. • Rest of the thyroid gland is not palpable
• Trachea is central.
• Bilateral carotid palpable
• No cervical lymphadenopathy

17. Auscultation
No bruit heard over the swelling
No eye signs
No pretibial myxedema
Spine, Scalp, ENT examination – Normal

18. Summary
• A 40 yr old lady has come with a painless, progressive swelling
over front part of neck without hypo or hyperthyroid symptoms,
pressure symptoms and features of metastasis. On
examination an oval shaped swelling of size 5×5 cm in present
in left lobe of thyroid probable diagnosis Left solitary thyroid
nodule.

19. Thank you