Mrs. Prabhati sahu, a 37-year-old female, presented with a 5-year history of a progressively enlarging, painless swelling in the front and sides of her neck. On examination, a butterfly-shaped swelling was observed involving both lobes of the thyroid and the isthmus. The swelling was nodular, firm, and mobile, and moved with deglutition. No cervical lymphadenopathy or signs of hyperthyroidism or hypothyroidism were present. Based on the history and examination findings, a provisional diagnosis of non-toxic multinodular goitre was made. Differential diagnoses considered included carcinoma of the thyroid, lymphoma, thyroglossal cyst,

1. LONG CASE PRESENTATION
ON
THYROID SWELLING
Dr Nirmalya Swain
3rd Yr PG,
Dept Of General Surgery

2. PATIENT PARTICULARS
•
•
•
•
Mrs. Prabhati sahu
37y/HF
Bhanjanagar, Ganjam
House wife

3. CHIEF COMPLAINTS
• Swelling in front and both sides of neck-
5yrs

4. H/O PRESENT ILLNESS
•
•
•
•
•
Swelling in front of neck-5yrs
Insidious onset
Progressive
Peanut size to the present size
Treated at a local clinic 5yrs back and took
medications for 2months ,then discontinued

5. •
–
–
–
•
Swelling Not Associated with
Difficulty in Breathing, Cough
Difficulty in Swallowing
Alteration of voice
Swelling Not Associated with Pain

6. •
–
–
–
–
–
–
•
No H/O
Weight Loss / Weight Gain
Irritability, Restlessness
Anxiety
Diarrhea / Constipation
Heat / Cold Intolerance
Bone pain,abdominal pain,psychiatric
manifestations
No H/O Fever, Night Sweats, Evening rise of
temperature

7. H/O PAST ILLNESS
•
•
No Similar illness in the past
Not a K/C/O T2DM, Hypertension,
Bronchial Asthma, TB

8. PERSONAL HISTORY
•
•
•
•
•
•
Married
Low Socio-Economic Status
Average Mixed Indian Diet
No addiction to Alcohol/Tobacco
Normal Sleep Pattern
Normal Bowel and Bladder habits

9. •
•
•
Attained Menarche at the age of 13years
3-4days/28-30 days, Normal Flow ,No Pain
Blessed with 2 Children, Younger one
being 10years old

10. FAMILY HISTORY
•
•
No H/O Similar illness
No H/O HTN, TB, T2DM

11. DRUG & TREATMENT HISTORY
•
•
•
•
Treated at a local Clinic- 5yrs back
Took Medications for 2months and then
discontinued it
No H/O Prolonged Drug intake
No H/O Radiation exposure

12. GENERAL EXAMINATION
•




After Taking Informed consent, I have
examined the patient with adequate light
and exposure.
Patient conscious, well oriented
BMI: 22.5 kg/m2
BP: 128/74 mm Hg
Pulse: 82/min

13. 


Temperature: Afebrile
Respiratory Rate: 14/min
No Pallor, Icterus,cyanosis, clubbing,
lymphadenopathy,edema

14. LOCAL EXAMINATION



INSPECTION
I have examined the patient in Sitting Position with
proper exposure and adequate light
A Butterfly Shaped
Swelling
Front and Both sides
Of Neck
Lt: 5 X 5 cm
Rt: 4 X 3 cm
Midline: 2 X 2 cm

16. 






Extent:
Superior: 1cm below Thyroid Cartilage
Inferior: 3cm above Sternal Notch
Laterally: Anterior Border of SCM in both sides
Colour: Normal
Border: Well Defined
Lower Border was Visible
Surface: Nodular

17. 




Skin: No Veins, No Scar
Moves with Deglutition
Does not Move with Protrusion of Tongue
No Pulsatile
No Visible Neck Veins

18. Deglutition

19. 







PALPATION
Temperature: Normal
Non Tender
Inspectory Findings were confirmed
Size: Lt: 5 X 5 X 3 cm
Rt: 4 X 3 X 3 cm
Middle: 2 X 2 X 2 cm
Extent:
Superior: 1cm below Thyroid Cartilage
Inferior: 3cm above Sternal Notch
Laterally: Anterior Border of SCM in both sides

20. 





Consistency: Firm
Margin: Well Defined
Lower Border was Palpable
Surface: Nodular
Non Pulsatile
Skin: Free
Mobile

21. 

Carotid Pulsation: Normal Site in Both
Sides
Trachea: Centrally Placed

22. Lahey’s method for right side

23. Lahey’s method for left side

25. Pemberton Test

26. 

PERCUSSION
On the Sternum: Resonant
AUSCULTATION
No Bruit over the Swelling

27. 
EXAMINATION OF
CERVICAL LYMPHNODES
No Visible / Palpable Cervical Lymph
nodes

28. SYSTEMIC EXAMINATION
•
•
CNS: No Focal Neurological Deficit
Power, Tone Normal
Reflexes Normal
No Tremors
EYE: No Eye Signs

29. •
•
CVS: S1 S2 Heard, No Murmur
RESPIRATOTY SYSTEM:
RR 14/min
Regular
Abdomino thoracic
B/L VBS
No adventitious sounds

30. •
•
ABDOMEN:
Soft, Non Tender
No Organomegaly
SKELETAL SYSTEM:
Normal
Normal Range of movements of
Cervical Spine

31. SUMMARY
•
•
Mrs. Prabhati sahu , 37y/HF with complaints
of a Butterfly shaped Swelling in front and
both sides of neck for 5 years, which was
Progressive, Painless without any history or
examination finding suggestive of
Hyperthyroidism, Hypothyroidism, Malignancy.
Swelling Moves with Deglutition, Nodular
Surface, Firm in Consistency without any
features of Compression, Fixity, Retrosternal
Extension or Palpable Cervical
Lymphadenopathy and Systemic Involvement.

32. PROVISIONAL DIAGNOSIS
• Non Toxic Multinodular Goitre involving
Both Lobes of Thyroid and Isthmus in
Clinically Euthyroid State

33. DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL
DIAGNOSIS
POINTS IN FAVOUR POINTS AGAINST
1. MULTI
NODULAR GOITRE
Painless Swelling
in Ant and Sides of
Neck
Slowly Progressive
Moves with
Deglutition
Nodular Surface
Firm Consistency
No Cervical
Lymphnodes
•
•
•
•
•
•

34. DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL
DIAGNOSIS
POINTS IN FAVOUR POINTS AGAINST
2. CARCINOMA
THYROID
Painless Swelling
in Ant and Sides of
Neck
Slowly Progressive
Moves with
Deglutition
•
•
•
Firm Consistency
Mobile
B/L Carotid
Pulsation felt
No Features of
Compression
No Cervical
Lymphodes
•
•
•
•
•

35. DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL
DIAGNOSIS
POINTS IN FAVOUR POINTS AGAINST
3. LYMPHOMA Swelling in Ant and
Sides of Neck
• Slowly Progressive
No H/O Fever,
Night Sweats,
Weight Loss
Firm Consistency
No Other Swellings
•
•
•
•
4.
THYROGLOSSAL
CYST
Swelling in Neck
Slowly Progressive
Moves with
Deglutition
•
•
•
Does not Move
with Protrusion Of
Tongue
•

36. DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL
DIAGNOSIS
POINTS IN FAVOUR POINTS AGAINST
5. TUBERCULAR
LYMPHADENITIS
Swelling in Neck
Slowly Progressive
•
•
No H/O Evening
rise of
Temperature , Fever,
Night Sweats,
Weight Loss
No Cough
•
•
6. THYROIDITIS Swelling in Ant and
Sides of Neck
Moves with
Deglutition
•
•
Painless
No H/O Fever or
URTI
No Features of
Hypo/
Hyperthyroidism
•
•
•

37. DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL
DIAGNOSIS
POINTS IN FAVOUR POINTS AGAINST
7. LIPOMA Painless Swelling
in Neck
Slowly Progressive
•
•
Moves with
Deglutition
Firm in
Consistency
Slip Sign Absent
•
•
•
8. SEBACEOUS
CYST
Painless Swelling
in Neck
Slowly Progressive
•
•
No Punctum
Moves with
Deglutition
Firm Consistency
•
•
•

38. THANK YOU