Thyroid History 3
Student Instructions
This female patient is presenting at the GP with swelling to her neck.
Take a focused history and offer a provisional diagnosis
Clinical Educators
Bradford Teaching Hospitals NHS Trust
Thyroid History 3
Patient Instructions
Mrs Jones, 38 Years of age.
Presenting complaint

Swelling to neck
History of Presenting Complaint
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Swelling in front of the neck
Became noticeable two weeks ago and has increased slightly in size
Swelling is pain free and non tender
Associated symptoms:
 Anxiety (becoming increasingly worse over the last two weeks, worse
when at work and at night when unable to sleep)
 Diarrhoea (started 1 week ago with loose, frequent stools, five/day)
 Sweating and hot even on cold days (sweating excessively on a
constant basis for last week, despite wearing cool clothes, antiperspirant doesn’t appear to help, worse at night in bed)
 Weight loss with increased appetite (clothes don’t appear to fit as well,
was previously a size 14 but can now fit in to her sisters’size 12
clothes)
 Insomnia (has been having palpitations at night and has had restless
nights for the last week, nothing appears to help)
 Bad tempered and snapping at husband and children without reason
(only noticed this recently in last few days, worse when tired and
anxious)
 Reduced bleeding when menstruating (last period finshed 1 week ago,
but lasted 1 day as opposed to 4)
Has been taking Nytol to help sleep and has been avoiding fatty foods to try
and alleviate diarrhoea, palpitations and insomnia but doesn’t appear to be
working.
Severity of symptoms gradually worsening
Past Medical History


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No similar problems in the past
Normally fit and healthy
Suffered with mild asthma as a child but no symptoms in adult life
Caesarian section with both children (now aged 10yrs and 7yrs)
Drug History



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No known drug or food allergies
Does not normally take any medication
Nytol (for insomnia for last 5 days)
Paracetamol 1g (last taken this morning for headache)
Clinical Educators
Bradford Teaching Hospitals NHS Trust
Thyroid History 3
Social History
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
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Lives with husband and two children in semi-detached house
Non-smoker but husband smokes 20/day (but not allowed to smoke inside the
house)
No history of drug abuse
Drinks a couple of glasses of wine on a Friday and Saturday night (approx 8
units/week)
Healthy, well balanced diet
Works as a secretary three mornings a week (but has been off work for past
week)
Family History


No history of thyroid problems in family
Mother and father fit and well
Clinical Educators
Bradford Teaching Hospitals NHS Trust
Thyroid History 3
Examiner
Did the student:
 Introduce themselves (1)
 Identify the site of the swelling (could be lymphadenopathy associated with
pulmonary TB)
(1)
 Identify the onset of the presenting complaint
(1)
 Identify whether the swelling was painful or non-tender
(1)
 Identify the associated symptoms
(1)
 Ask further question concerning the associated complaints, i.e.:
 1.Anxiety (onset, timing, exacerbating/relieving factors, severity) (1)
 2.Sweating (site, onset, timing, exacerbating / relieving factors,
severity) (1)
 3.Diarrhoea (onset, timing, exacerbating/relieving factors, severity) (1)
 4.Weight loss (onset, severity) (1)
 5.Insomnia (onset, exacerbating/relieving factors, severity) (1)
 6.Mood change (onset, timing, exacerbating/relieving factors, severity)
(1)
 7.Menorrhagia (onset, timing, exacerbating/relieving factors, severity)
(1)
 Ask pertinent/appropriate questions related to presenting complaint (previous
problems, operations) (1)
 Ask about JADE, TAB, MARCH (thyroid should have already been covered)
(2)
 Ask about drug history and allergies (and include recent medication that pt is
no longer taking) (2)
 Ask pertinent social history questions (1)
 Ask if thyroid problems run in the family (1)
Did the patient display:
 Professional and polite manner (1)
 Systematic, logical approach to history taking (2)
Provisional diagnosis – Hyperthyroidism (with goitre) (2)
Marks out of 24 ____
Clinical Educators
Bradford Teaching Hospitals NHS Trust