A 41-year-old female presented with a 4-year history of a gradually enlarging neck swelling. On examination, she was found to have a globular, smooth, mobile thyroid swelling measuring approximately 8x7x4 cm without any symptoms of hyperthyroidism or hypothyroidism. Based on the history and examination, the provisional diagnosis was colloid goiter.

1. Moderator : Dr(Prof) Isha Preet Tuli
Co moderator : Dr Debopriya Saha
Presented by : Dr Krishan Rajbhar
CASE PRESENTATION: THYROID

2. PATIENT INFORMATION
Ram Kanya
41 yr/F
Housewife Informant -self
R/O New Delhi (reliable)
Presented with the chief complaints of:
Swelling front of neck since 4 years

3. HISTORY OF PRESENT ILLNESS
 Patient was apparently well 4 years back when she developed a swelling front of
neck which was insidious in onset gradually progressive (progressed from size
of pea to current size with due course of time),persistent without any
aggravating or relieving factors.

4. No history of
 No history of neck trauma
 No history of pain over Swelling
 No history of pus point or discharge over the swelling
 No history of difficulty in breathing/swallowing
 No history of change in voice
 No history of swelling elsewhere in neck
 No history of radiation exposure in childhood
 No history of loss of appetite, significant weight loss, chronic cough, evening
rise of temperature & night sweats

5.  No history of palpitation, tachycardia, excessive sweating, mood changes,
menstrual abnormalities, increased appetite, loose stool, tremors, intolerance
to hot & decreased sleep
 No history of decrease appetite, constipation, depression, irregular menses,
intolerance to cold dry skin, increased sleep & excessive weakness.
 No history of periorbital swelling, swelling over lower legs.
 No history of loss of consciousness, seizures ,headache, chronic cough, blood
in sputum, shortness of breath, blood in vomitus, blood in stool, abdominal
pain, jaundice, frequent fracture and bone pain
 No history of any other ear, nose & throat complaints.

6. PAST HISTORY
 Patient is K/C/O hypothyroidism on tab thyroxin sodium 50 mcg OD
 No h/o of HTN/TB/DM/asthma/seizures/jaundice/blood transfusion/any
significant medical or surgical illness.
FAMILY HISTORY
 No similar complaints in the family.
 No significant family history.

7. PERSONAL HISTORY
 Housewife
 Mixed diet
 Normal sleep pattern
 Normal bowel and bladder habits
 No addiction
 Last menstrual period on 2 may 2022 , normal flow and regular cycle.
 Socioeconomic status -lower middle class

8. GENERAL PHYSICAL EXAMINATION
Patient is examined after taking proper consent in a well illuminated room in sitting
position.
 Pt is conscious, cooperative, well oriented to time, place and person.
VITALS
 Pulse-84/min, normal in character, volume, taken in right radial artery in sitting
position with no radio-radial or radiofemoral delay.
 RR-14 /min.,regular
 BP-110/74 mm hg ,right arm, sitting position at the level of heart.
 Temperature- afebrile
 No pallor, icterus, cyanosis, clubbing, significant Lymph Node enlargement or
oedema.
 JVP not raised.
 No evidence of dry skin or increased sweating in hands, palmar erythema, hands
tremor, tongue tremor, no eye signs.

9. SYSTEMIC EXAMINATION
 Cardiovascular system-S1,S2 heard normally, no murmurs
 Central nervous system -no gross sensory or motor deficit.
 Respiratory System-bilateral air entry equal, normal vesicular breath
sounds heard, no added sounds.
 Per Abdomen-soft, nontender, no organomegaly.

10. EXAMINATION OF FACE AND NECK
On Inspection:
• A globular swelling(8 * 7*4 cm )present over
anterior aspect of neck over thyroid region
extending
• Horizontally from anterior border of R.
sternocleidomastoid muscle to approx 1 cm posterior
to ant border of L. SCM .
• Vertically from superior border of thyroid cartilage
to 0.2 cm above suprasternal notch .

11.  Swelling moves with deglutition and lower margin of
swelling can be visualized.
 Swelling does not move on tongue protrusion .
 Neck movements normal,skin over swelling normal, no
pus point or discharge.
 No scar,sinus and fistula.
.

14. Swelling is palpated from behind the patient in sitting and neck flexed position
 On palpation
Inspectory finding confirmed- No rise in local temperature , non tender, smooth
surface with define margin, soft to firm in consistency with no pulsation,
swelling is mobile in horizontal plane, nonfluctuant, nonreducible, lower margin
of swelling can be palpated.
 Skin overlying swelling is pinchable
 Trachea is central in position and laryngeal crepitus present.
 Bilateral carotid pulsation palpated at normal site.
 No palpable cervical lymphadenopathy.

15.  On percussion
over manubrium sterni a resonant note is obtained
 On auscultation
no bruit is audible over neck swelling.

16. ORAL CAVITY
 Mouth opening adequate
 Orodental hygiene fair
 Tongue & its mobility normal.
 Palate & uvula normal
 Bilateral tonsillar pillar & fossa normal
 Posterior pharyngeal wall clear

17. INDIRECT LARYNGOSCOPY
 Epiglottis normal
 Bilateral arytenoids & aryepiglottic folds normal
 Bilateral false vocal cord normal
 Bilateral true vocal cord mobile and chink adequate
 Bilateral pyriform sinus clear
Ear and nose examination was with in normal limit

18. SUMMARY
 A 41 year old female, housewife, resident of New Delhi ,presented
with painless, gradually progressive, non fluctuant, globular neck
swelling (approx.8*7*4 ) since 4 years . Swelling moves with
deglutition with no feature of hyper or hypothyroidism and no
evidence of retrosternal extension ,pressure symptoms or
malignancy.

19. DIAGNOSIS
On the basis of history and clinical examination my provisional diagnosis is
colloid goitre.

20. THANK YOU