examination

1. Solitary Thyroid Nodule
DR. JAGADISH N
GENERAL SURGERY

2. Name- Rajani Jhariya
Age – 30years
Sex- female
Married
Religion- Hindu
R/O- Jabalpur, MP
Housewife

3. Chief complaints
Swelling in front of the neck since 6years

4. History of presenting illness:
oPatient was apparently alright 6 years back, when she noticed a swelling in
front of the neck which was insidious in onset, initially when she noticed it was
about 2cm gradually progressed towards left side of neck to attain present size.
oThere is no h/o sudden increase in the size of the swelling
oSwelling is not associated with the pain

5. oThere is no h/o dyspnoea or dysphagia or hoarseness of voice
oNo h/o loss of weight, heat intolerance, sleep disturbance, diplopia,
palpitations, dypnoea on exertion
oNo h/o weight gain, cold intolerance, loss of hair or constipation
oNo h/o cough with haemoptysis, bony pain or convulsions

6. Past history
Patient consulted elsewhere for the same complaints 5years back where they
advised homeopathy medications (documents not available). She stopped taking
those medications after 3months on her own
Not a k/c/o T2 DM, HTN, PTB, hypo/hyperthyroidism, epilepsy or bronchial
asthma
No h/o prior irradiation to neck

7. Personal history
Patient is married
Consumes mixed diet
Consumes iodised salt
Appetite normal
Bowel and bladder habits are normal
Normal sleep pattern
No h/o any drug allergies
H/o Gutkha chewing for 10years

8. Menstrual history
Attained menarche at 13years
Cycle is regular with 2-3days of bleeding/28-30days
No h/o amenorrhoea, menorrhagia
She is P3L3

9. Family history
No h/o similar complaints amongst the family member
No h/o thyroid cancer/ any other malignancy/ unexplained death in the family

10. General physical examination
Patient is conscious oriented to time, place and person
BMI -21kg/m2
No pallor/icterus/cyanosis/clubbing/pedal edema/generalised
lymphadenopathy
Pulse- 92/min
Regular, normal rhythm and volume
BP- 114/70mm of hg
Measured in right arm in supine position
SpO2- 98% on room air

11. Head: no alopecia
Normal facies
Eye: no eye signs, no madarosis
Tongue: no tremor
Palms: no moist skin, no tremor

12. Systemic examination
CNS- Patient is conscious oriented to time, place and person
CVS- S1 S2+ no murmur heard
RS- b/l air entry equal
P/A- soft, non tender
- no organomegaly
- no ascites present

13. LOCAL EXAMINATION- NECK
In sitting position with adequate exposure of neck and upper chest.
1. INSPECTION:

15. There is evidence of single horizontally oval shaped swelling of about 6*8cm
over the anterior aspect of neck
Vertical extent: lower margin just above the suprasternal notch and upper
margin is about 6cm from suprasternal notch
Horizontal extent: left side upto posterior border of sternocleidomastoid muscle
and right side about 2cm medial to anterior border of sternocleidomastoid
muscle.

16. All borders well defined
Surface appears smooth
Skin over swelling appears normal
Tattoo mark over the swelling present
Moves vertically upwards with deglutition
Does not moves with protrusion of tongue
No other visible swelling in the neck
No engorged veins over neck or upper chest

17. PALPATION
No local rise of temperature or tenderness
All inspection findings about size, shape, borders and surface are confirmed by
palpation
Firm in consistency
Nodule mobile both horizontally and vertically
Right lobe of thyroid is palpable, firm in consistency
B/l carotid pulse palpable
Trachea is slightly deviated towards right side

18. Palpable lymph nodes present in right posterior triangle
•Two in number
•Soft in consistency, non tender
•Each about 1*1cm, flattened surface
•Mobile
•Skin over the lymph nodes normal

19. PERCUSSION: resonant note present over manubrium
sterni
ASCULTATION: no bruit over the swelling

20. SUMMARY
A young female presented with swelling in front of neck since 6years, which
was gradually progressive in nature with no pressure symptoms or any specific
symptoms suggestive of hypo/hyperthyroidism. On examination, 6*8cm firm
non-tender nodule found which moves on deglutition, with well defined
borders.

21. PROBABLE DIAGNOSIS
Benign euthyroid solitary nodule in left lobe of thyroid

22. THANK YOU