A 46 year old female came with the chief complaints:


THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT."



A 46 year old female came with the cheif complaints of:
 swelling in the neck since 1 year,
 hoarseness of voice since 6 months
Difficulty in swallowing since 6 months
Weight loss since 2 months
Burning micturation since 10 days

HOPI:

Patient was apparently asymptomatic 1 year back then she observed a pea sized swelling in neck , which gradually progressed  to present size ,not associated with pain, swelling moves on swallowing https://youtube.com/shorts/2CpO9BdlhGc?feature=share

Past history :

Not a known case of TB,DM ,Asthma,HTN,Epilepsy

She is a known case of  thyroid 

Treatment history:  under carbimazole 10mg since  1 year 

Personal history:

Diet : She wakes up at 5:30 in the morning and completes her daily activities and prepares food.She will have her food(rice and curry) go to her work by 10:30am.She consumes lunch by 2:00pm (rice,dal and curd) and completes her work and goes home by 6pm.She then completes her house hold works and prepares dinner and have it by 9:30pm and sleeps by 10:30pm.

Appetite: decreased 

Sleep : adequate

 Bowel habits : regular

Bladder habits: burning micturition since 10 days

Addictions: occasionally consumes  toddy

Not allergic to any kind of food and drugs

Family history: not significant 

GENERAL EXAMINATION:

Patient is concious coherent coperative well oriented to time place and person 

She is moderately built and nourished

Pallor: Present


Edema :Pedal edema extended upto knee

No icterus , cyanosis,lymphedenopathy ,clubbing 




VITALS 

Temperature: 98.5F

Pulse rate :112bpm

Respiratory rate: 18 cpm

BP: 11/80mmHG

Spo2: 99%

SYSTEMIC EXAMINATION:

Respiratory system: Bilateral air entry present ,NVBS heard

CNS : no focal neurological deficits

CVS:S1 , S2 heard ,no murmurs

Per abdomen : soft , non tender , no organomegaly

Local examination:

Inspection: swelling present in centre of neck move upward on deglutition

Palpation: A firm thyroid gland is felt, no palpable lymphn nodes

Investigations:


ECG:

USG neck(outside report)


LFT:



Provisional diagnosis: Toxic adenoma?

Plan:conservative management

Radioactive iodine destroys thyroid gland slowly

Surgical: Thyroidectomy(later treat for hypothyroid)




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