DIFFUSE GOITRE
WITH
HYPOTHYROIDISM
M. Vidhya
Roll. No 92
S3 unit department of surgery
32 years female Mrs.Shanthi from Valavanur house
wife by occupation came to OPD with c/o swelling in
the front of neck for past 6 months
History Of Presenting Illness
Patient was apparently normal before 6 months then
she noticed swallowing in the front of the neck which
was noticed by herself.
- Insidious in onset
- Initially small in size gradually progresive to
attained present size
- Not associated with pain
- No H/O Any other swelling in neck
- No H/O Trauma
- No H/O Fever
- No H/O Difficulty in breathing
- No H/O Difficulty in swallowing
- No H/O Voice change
- No H/O Syncope
- No H/O Excess sweating
- No H/O Loss of weight
- No H/O Heat intolerance
- No H/O Diarrhoea
- No H/O Sleepless night
- No H/O Muscle weakness
- No H/O Tumors
- No H/O Difficulty in closing eyes
- No H/O Double vision
- H/O fatigue
- H/O weight gain (in spite of poor appetite)
- H/O cold intolerance
- H/O constipation
- H/O loss of hair
- No H/O Hoarseness of voice
- H/O Oligomenorrhea (once in 45 days)
- No H/O Palpitation
- No H/O Dyspnea on exertion
- No H/O Ankle edema
- No H/O Chest pain
- No H/O Loss of appetite
- No H/O Chronic cough with hemoptysis
- No H/O Headache
- No H/O Vomiting
- No H/O Bone pain
- No H/O Any other swelling in neck
- No H/O Jaundice
Past History
- No H/O Similar illness in the past
- No H/O Diabetes Mellitus,Tuberculosis, Bronchial
asthma, Epilepsy, Hypertension
- No H/O Previous neck surgeries
- No H/O Irradiation
- No H/O Drug intake
Personal History
- Consumes mixed diet, not smoker, not alcoholic
- Normal sleep pattern
- No H/O Substance abuse, takes iodized salt
- No H/O Excessive intake of goitrogens
Family History
-No Significant family history
Menstrual History
- Age at menarche - 14 years
- Oligomenorrhea parent
- Irregular cycle once in 45 days
- Normal flow (for 5 days)
- No clots not associated with pain
- No H/O use of OCP pills
Marrital History
-Non-consanguineous marriage
-Have 2 children
Summary
32 years old female Mrs.Shanthi came to OPD with
chief complaints of swelling in anterior aspect of
neck for past 6 months insidious in onset, initially
small in size gradually progresive to attained present
size not associated with pain with history of
hypothyroidism, no history suggestive of
hyperthyroidism, no history suggestion of
metastasis, with no other relevant
Significant history, probably a case of benign thyroid
swelling.
With this given complaint I would like to examine this
swelling.
General Examination
After getting consent from the patient was examined
in a sitting position. Patient was comfortable,
oriented, moderately built and nourished
- Pallor present
- No icterus
- No Cyanosis
- No Clubbing
- No evidence of toxic eyesigns
General Survey
- Hair : Hair loss present
- Skin : Dry
- Face : Mask Like face
- Limbs : No tumor
- Eyes : No toxic eyesigns
- Oral cavity : Mactoglossia present
Vitals
- Pulse Rate : 56/min [normal rhythm, volumes
character]
- No radio delay,
- No radiofemoral delay
- No vessel wall thickening
- BP : 110/70 mmHG
- Temperature : Afebrile
- Respiratory rate : 18/min
Local Examination
Inspection
A diffuse swelling of size 10*8 cm present on the
anterior aspect of the neck which is in butterfly
shape.
- Extent : above : Thyroid cartilage
below : Sternal notch
Lateral : Sternocleidomastoid
- Smooth surface
- Well defined margin
- Swelling moves with deglutition
- Lower border of swelling seen
- Skin one swelling normal
- No sinus scar,dilated veins
- No visible pulsation
- No other swelling in neck
- Trachea position not seen due to differs swelling
Palpation
- Not warmth, not tender
- Inspectory findings about site size shape, size
extent surface of swelling is confirmed
- Firm is consistency
- Mobility : Moves with deglutition
- Trachea in midline
- No other swelling present
- Carotid pulsations felt on both sides
- No palpable thrill
- Kocher’s test : negative
- Pemberton sign : not applicable
Auscultation
- No bruit heard over gitre
Systemic Examination
- RS : normal vesicular breath sounds
- CNS : S1S2 heard
No murmur
- Abdomen : Soft, non-tender, no free fluid, no
organomegaly
- CNS : No focal neurological deficit
Summary
32 years old female Mrs.Shanthi came to OPD with
chief complaints of swelling in anterior aspect of
neck for past 6 months, with history of
hypothyroidism on examination, diffuse painless
swelling of size 10*8 cm seen on the anterior aspect
of neck butterfly shaped margins well defined, firm
in consistency, with no palpable lymph nodes.
Provisional diagnosis
If is a case of diffuse goitre with hypothyroidism
Investigations
1. Thyroid function test
2. USG neck
3. FNAC
4. CBC X-ray of neck, chest X-ray
5. ANH Thyroid peroxidase
6. Anti-TAG