thyroid swelling

1. CASE PRESENTATION
THYROID SWELLING
BY: Dr. Ankur Jain
NSCB, MCH,Jabalpur

2. •Name- Savitri
•Age – 60 year
•Sex-female
•Married
•Religion- Hindu
•R/O- Jabalpur, MP
•Housewife

3. Chief complaints
•Swelling in neck for around 2 years
•Hoarseness of voice for 2 months

4. History of present illness
•Patient complains of swelling in front of neck for last
two years
-insidious in onset
-initially small in size
-rapid increase in size for last 2 months
- skin discoloration over the swelling
•Associated with hoarseness of voice for last 2 months

5. Not associated with
•Pain
•Fever
•Difficulty in eating
•Difficulty in breathing
•Significant weight loss / loss of appetite/ tremors/
palpitation/ hair loss/ muscle weakness/ sleep
disturbance , cold or heat intolerance.
•No h/o haemoptysis, convulsions or jaundice/ bony pain
•No history of any other swelling in neck or scalp or any
where in the body

6. Past history
•No h/o – DM, HTN, bronchial asthma
-tuberculosis
-irradiation to head and neck region
•h/o CVA present – 5 years back
•No history of any similar swelling in past or any surgical
illness

7. Personal history
•Patient is married
•Vegetarian by diet, consumes iodised salt, no h/o
excessive consumption of vegetables related to brassica
family.
•Non smoker and non alcoholic
•Bladder bowel habits are normal
•No allergies or any drug addiction
•Normal sleep pattern.
•Patient attained menopause at 45yr age.

8. Family history
•No h/o of similar swelling amongst family member
•No h/o any cancer or hereditary disease in any family
member

9. General examination
• Alert oriented to time, place and person
• Afebrile
• Average built and nourishment (BMI-21),
• Karnofsky performance scale-90%
• Normal facies,
• No pallor/icterus/cyanosis/loss of hair
• No lymphadenopathy,
• No pedal edema
• Skin – normal without any excessive sweating or dryness
• P-90/min ,regular ,normal rhythm and volume, no radio-radial or
radio-femoral delay
• Bp- 116/76 mmhg

10. Systemic examination
•CNS- patient is conscious oriented to time ,place and
person
•RS- clear, b/l air entry equal
•CVS- s1s2 heard , no murmur present
•PA- soft, noT/G/R
-no organomegaly
- no ascites present

12. Neck examination
on inspection
•There is visible swelling of around 20*15 cm in neck
region,
•irregular in shape
•extending from post border of left SCM to right side of
neck. And superiorly angle of mandible, inferiorly up to
clavicle on both side.
• bosselated appearance
•Movement on deglutition present

13. •Skin overlying swelling is shiny , stretched and
hyperpigmented
•Dilated veins over swelling and over chest wall
•No scar mark/no visible pulsation seen in neck
•No other swelling apart from this swelling seen in neck
•Pemberton sign absent

14. On palpation
•No local rise of temp and tenderness
•Multinodular swelling present in front of neck.
•Size of swelling was around 18*14 cm. shape – irregular
• variable consistency – ( solid, cystic and firm) , margins
– well defined
•Which is extending vertically from thyroid cartilage
above up to suprasternal notch below

15. •Horizontally extending beyond the right posterior
border of SCM and upto left anterior border of
trapezius.
•Swelling moves upwards with deglutition.
•Skin overlying swelling is not pinchable.
•Trachea not palpated.
•Right carotid pulse is not palpable
•

16. Examination of cervical lymph
node
•No lymphadenopathy present

17. On percussion
•Over manubrium sterni – resonant note present
On auscultation
- bruit over the swelling+

18. Case summary
•60 year lady presented with painless swelling over neck
for last 2 years with rapidly progressed for past 2
months in thyroid region, with h/o hoarseness of voice
for past 2 months in euthyroid state.
•On examination , 18*14 cm multinodular irregular
swelling over neck with well defined margins, variable
consistency with stretched shiny skin and
hyperpigmentation, moving with deglutition with right
carotid pulse not palpable, no retrosternal extension,
with some dilated veins over swelling and neck, all
border of swelling are palpable. No cervical
lymphadenopathy.

19. Provisional diagnosis
•Carcinoma thyroid with RLN involvement in euthyroid
state.