The document presents a clinical examination of a 32-year-old woman with a progressive, painless swelling of 4x3 cm in the left side of her neck, consistent with multinodular goitre. She has no symptoms suggestive of thyroid dysfunction or malignancy, and her overall clinical status is euthyroid. The examination indicates that the rest of the thyroid gland is nodular, with no local rise in temperature or tenderness.

1. Clinical Examination of Thyroid
Swelling

2. Demographics
 Name: Mrs X
 A/S: 32/F
 Residence: House No 143, Vijaynagar, Mandla, Madhya Pradesh
 Occupation: Housewife

3. Chief Complaint
 Swelling in front of the neck since 2 years

4. History Of Presenting Illness
 C/o swelling in the front of the neck since past 2 years. It was initially
noticed on the left side of the neck.
 It was insidious in onset and gradually progressive
 It was painless
 There was no h/o difficulty in breathing/swallowing or any change in voice
 There is no h/o lethargy/ weight gain/ loss of appetite/ constipation or cold
intolerance
 There is no h/o anxiety/ weight loss/ increased
appetite/diarrhoea/excessive sweating or heat intolerance

5. Past History
 No h/o Diabetes, Hypertension, pulmonary tuberculosis/ asthma.
 No h/o any surgical intervention in the past

6. Personal History and Menstrual
History
 Patient consumes a vegetarian diet.
 She has normal bowel and bladder habits.
 There is no h/o any sleep disturbance.
 LMP: 18th July, regular 4-5 day cycle
 Married since 8 years, has a single 6 year old son

7. Family History
 Her mother had a similar swelling in the neck.
 Several people in her neighborhood have a similar swelling in the
neck.

8. General Examination
 Patient is conscious, cooperative and well oriented to time, place and
person
 Vitals:
 Pulse : 88 bpm, normal in rate, rhythm, volume and character
 BP: 124/86 mmHg, in Right arm supine position
 Respiratory rate: 22/min
• Pallor +
• No cervical lymphadenopathy/edema
• No eye signs

9. Systemic Examination
 CNS: Conscious and oriented, no tremors
 CVS: S1 S2 heard. No murmurs
 Per Abdomen: Soft, bowel sounds +
 RS: Upper Airway : Trachea appears to be in the midline. No stridor
: Lower Airway: B/L air entry is equal. No added sounds

10. Examination of Neck
 Inspection:
A swelling of 4X3 cm is visible on the
left side of the neck, with well defined
borders. Has a smooth surface.
It moves with deglutition
Its lower border is visible
Skin above the swelling appears
normal

11. Examination of Neck
 Inspection:
A swelling of 4X3 cm is visible on the
left side of the neck, with well defined
borders. Has a smooth surface.
It moves with deglutition
Its lower border is visible
Skin above the swelling appears
normal
Video showing movement with deglutition

12. Examination of Neck
 Palpation:
A swelling of 4X3 cm is palpated on the
left side of the neck, with well defined
borders and smooth surface.
The surface of the rest of the thyroid
gland seems to be nodular.
Moves with deglutition
There is no local rise in temperature or
tenderness
Kocher’s test ( small swelling, hence
not required)

13. Examination of Neck
 Palpation:
A swelling of 4X3 cm is palpated on the
left side of the neck, with well defined
borders and smooth surface.
The surface of the rest of the thyroid
gland seems to be nodular.
Moves with deglutition
No local rise in temperature or
tenderness
Carotid artery is palpable on both sides
equally
No cervical lymphadenopathy

14. Examination of Neck
 Percussion:
Percussion over the manubrium gives a resonant note
 Auscultation:
No bruit heard over the thyroid gland

15. Summary
 A young lady with slowly progressive swelling in the front of neck
on the left side which is 4x3 cm in size and moves up with
deglutition with no features of hypo or hyperthyroidism and no
evidence of pressure symptoms or malignancy.
 Rest of the thyroid gland is nodular.

16. Diagnosis
On the basis of the history and clinical examination my diagnosis is:
Multinodular goitre with dominant nodule with clinically euthyroid
status in a young lady.