General Medicine Blog-4

March 18, 2022

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's 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 patient's clinical problems with collective current best evidence based inputs.

A 27 year old female patient, resident of Nalgonda, tailor by occupation, came to our hospital with chief complaints of-
1. Swelling infront of neck
2. Shortness of breath

Date of admission :- 15/03/2022

History of present illness:-
Patient was apparently asymptomatic 20 days back and developed swelling which is insidious on onset and gradually progressive, not associated with pain, difficulty in swallowing, intermittent pain only during cold.
A 4×3, single, oval swelling present infront of neck, extending vertically 2cm below thyroid notch to 1cm above Suprasternal notch and horizontally from anterior border of Right SternoCleido Mastoid muscle to 1cm to left from midline.

History of past illness:-
Not a known case of diabetes, hypertension, tb, epilepsy
2 years ago she had same problem.
Initially the size of swelling measured nearly the size of peanut, gradually increased to the size of lemon
No aggrevating factors
No relieving factors
No pain
No pressure symptoms like-
1. Difficulty in breathing
2. Difficulty in swallowing
No voice change
No symptoms suggestive of hyperthyroidism like-
1. Weight loss
2. Increased appetite
3. Palpitations
4. Sweating
5. Anxiety
6. Intolerance to heat
No symptoms suggestive of hypothyroidism like-
1. Weight gain
2. Decreased appetite
3. Diarrhoea
4. Intolerance to cold

Personal history:-
Patient has normal eating habit with mixed diet.
Takes toddy occasionally.

Daily routine:-
Patient used to wake up at 6.00AM , takes breakfast in between 10.00AM-11.00AM. Then she does tailoring, and takes rice in between 2.00PM-3.00PM and dinner at 10.00PM and goes to bed by 12.00AM.

Family history:-
No significant family history.

General examination:-
Patient is conscious, coherent, cooperative and well oriented to time, place and person.
No pallor
No icterus
No clubbing
No lymphadenopathy

Vitals:-
Temperature-99 F
Pulse rate- 88 bpm
RR-16 cpm
BP-120/90 mmhg
SPO2-97% at room air
RBS-96mg/dl




Investigations:-
APTT
CUE
T3, T4, TSH
CBP
RFT
LFT
Blood Sugar-Random
Prothrombin time
Bleeding and Clotting time
Ultra sound scan
ECG

Provisional diagnosis:-
Papillary Carcinoma Thyroid

Pre-operative medication:-
Tab. Augmentin 12gm
Inj. Pantop 40mg × IV × BD
Inj. TT ½ CC IM STAT
Inj. 2% Xylocaine with Adrenaline
Tab. Restyl 0.25mg
Tab. Thyronorm 25mcg with only a sip of water

Treatment:-
Tab. Thyronorm 25mcg × QD
Tab. MVT × QD
Tab. Metrogyl 400mg × TID
Tab. Sporolac × BD
Surgery suggested:-Total Thyroidectomy

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