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    Multinodular Goitre CASE PRESENTATION

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    dr.atul jaiswal
    A 55-year-old woman presented with a swelling on her neck that had grown over 1.5 years. She reported hoarseness for 6 months, difficulty swallowing solids for 4 months, and difficulty breathing for 1 month. On examination, she had a large, firm swelling involving both thyroid lobes and the isthmus, which extended below her collarbone and into her chest. Her symptoms suggested a provisional diagnosis of a non-toxic multinodular goiter causing compressive symptoms.

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    Multinodular Goitre CASE PRESENTATION

    Uploaded by

    dr.atul jaiswal
    43 views18 pages
    A 55-year-old woman presented with a swelling on her neck that had grown over 1.5 years. She reported hoarseness for 6 months, difficulty swallowing solids for 4 months, and difficulty breathing for 1 month. On examination, she had a large, firm swelling involving both thyroid lobes and the isthmus, which extended below her collarbone and into her chest. Her symptoms suggested a provisional diagnosis of a non-toxic multinodular goiter causing compressive symptoms.

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    Multinodular goitre CASE PRESENTATION

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    A 55-year-old woman presented with a swelling on her neck that had grown over 1.5 years. She reported hoarseness for 6 months, difficulty swallowing solids for 4 months, and difficulty breathing for 1 month. On examination, she had a large, firm swelling involving both thyroid lobes and the isthmus, which extended below her collarbone and into her chest. Her symptoms suggested a provisional diagnosis of a non-toxic multinodular goiter causing compressive symptoms.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    43 views18 pages

    Multinodular Goitre CASE PRESENTATION

    Uploaded by

    dr.atul jaiswal
    A 55-year-old woman presented with a swelling on her neck that had grown over 1.5 years. She reported hoarseness for 6 months, difficulty swallowing solids for 4 months, and difficulty breathing for 1 month. On examination, she had a large, firm swelling involving both thyroid lobes and the isthmus, which extended below her collarbone and into her chest. Her symptoms suggested a provisional diagnosis of a non-toxic multinodular goiter causing compressive symptoms.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 18

    CASE PRESENTATION

    BY:
    DR VINEET MOHAN SAMAL
    DNB FINAL YEAR RESIDENT
    FORTIS ESCORTS HOSPITAL,FARIDABAD
    PATIENT PARTICULARS

    • NAME : Mrs Heera Devi


    • Sex: female
    • Age : 55 years
    • Occupation : home maker
    • Address : Faridabad
    CHIEF COMPLAINTS

    • Swelling on the front of the neck and sides for the past 1.5 years
    • Increase in size of the swelling for past 6-7 months
    • Hoarseness of voice for past 6 months
    • Difficulty swallowing for past 4 months
    • Difficulty breathing for the past 1 month
    HISTORY OF PRESENT ILLNESS

    The patient was apparently well 1.5 years ago, after which she noticed
    a swelling in the front of her neck on the left of midline, which was
    insidious in onset and about 1 by 1 cm in size. The swelling gradually
    increased in size to involve the other side and attain the present size.
    She also gives history of hoarseness of voice for the past 6 months,
    difficulty swallowing solids for the past 4 months and difficulty
    breathing for the past 1 month. There is no history of symptoms
    suggestive of hypo or hyperthyroidism.
    HISTORY OF PAST ILLNESS

    • Known hypertensive on regular medication for the past 10 years


    • No history of any other medical illnesses.
    • No surgical history
    PERSONAL HISTORY

    • Married with 2 children


    • Spouse and children – healthy
    • Mixed diet, appetite - normal
    • No addiction history
    • Bowel and bladder habits – normal
    • Sleep – normal
    • Middle class according to Kuppuswamy scale
    • Post menopausal for last 7-8 years
    FAMILY HISTORY

    • Parents died of natural cause.


    • Siblings are alive and healthy
    • No family history of thyroid disorders.
    • No family history suggestive of MEN related malignancies.
    TREATMENT HISTORY

    • NONE
    CASE SUMMARY

    • A 55 years old lady, Mrs Heera Devi presented with swelling on front
    of her neck for the past 1.5 years associated with hoarseness of voice
    for past 6 months, dysphagia for solids for the past 4 months and
    dyspnea for 1 month, without any symptoms suggestive of hypo or
    hyperthyroidism.
    PHYSICAL EXAMINATION

    1. GENERAL SURVEY
    * conscious, alert, co operative
    • score 90 on karnofsky performance scale
    • no pallor, cyanosis, clubbing, oedema, jaundice or generalized
    lymphadenopathy
    • Pulse – 84/min, BP- 130/82 mm of Hg, RR – 20/min, SpO2- 99 % on
    room air, afebrile
    2. Local examination

    A. Inspection
    • A butterfly shaped swelling visible in the thyroid region extending
    laterally upto the sternocleidomastoid on both sides, below till the
    supra sternal notch and above upto the cricoid cartilage.
    • Surface : smooth
    • Margins : well defined
    • Skin over the swelling : smooth with lobulations
    • No visible pulsations
    • Moves with deglutition
    B. PALAPATION

    • Inspectory findings were confirmed on palpation


    • Temperature : not raised over the swelling
    • Non tender to touch
    • Swelling appears to involve both the lobes and the isthmus and lies in
    the thyroid region, extending laterally till the sternocleidomastoid on
    both sides, superiorly till the cricoid cartilage, inferiorly till the clavicle
    and below the supra sternal notch( finger insinuation was not
    possible)
    • Right half of the swelling measures 6 by 5 cm, left half measures 6 by
    6 cm and in the midline it measures 3 by 4 cm.
    • Swelling moves up and down with deglutition
    • Firm in consistency
    • Mobile from side to side and up and down
    • Trachea in midline
    • Carotid pulsations present
    • No pulsations, thrill, skin fixity or enlarged cervical nodes.
    C. PERCUSSION

    • Superior mediastinum was dull on percussion, suggesting retrosternal


    extension.

    • D. AUSCULTATION
    No bruit

    E. Examination for toxic signs


    No findings suggestive of toxic goiter were present
    Summary
    • 55 year old post menopausal, hypertensive lady from Faridabad
    presented with a swelling on the front and sides of her neck for the
    past 1.5 years with hoarseness for the past 6 months, dysphagia to
    solids for 4 months and dyspnea for past one month without any
    other history suggesting hypo or hyperthyroidism, without any
    significant family history.
    • On examination,general survey was essentially normal. On physical
    examination, the swelling was butterfly shaped involving both the
    lobes of thyroid and the isthmus, moved with deglutition with
    retrosternal extension but without any toxic signs.
    Provisional diagnosis

    • A case of non toxic multi nodular goiter involving both the lobes of
    thyroid and the isthmus with compressive symptoms.

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