Clinical Examination of Thyroid Swelling

DemographicsName: Mrs X

A/S: 32/F

Residence: House No 143, Vijaynagar, Mandla, Madhya Pradesh

Occupation: Housewife

Chief ComplaintSwelling in front of the neck since 2 years

History Of Presenting IllnessC/o swelling in the front of the neck since past 2 years. It was initially

noticed on the left side of the neck.

It was insidious in onset and gradually progressive

It was painless

There was no h/o difficulty in breathing/swallowing or any change in voice

There is no h/o lethargy/ weight gain/ loss of appetite/ constipation or cold intolerance

There is no h/o anxiety/ weight loss/ increased appetite/diarrhoea/excessive sweating or heat intolerance

Past HistoryNo h/o Diabetes, Hypertension, pulmonary tuberculosis/ asthma.

No h/o any surgical intervention in the past

Personal History and Menstrual History

Patient consumes a vegetarian diet.

She has normal bowel and bladder habits.

There is no h/o any sleep disturbance.

LMP: 18th July, regular 4-5 day cycle

Married since 8 years, has a single 6 year old son

Family HistoryHer mother had a similar swelling in the neck.

Several people in her neighborhood have a similar swelling in the neck.

General ExaminationPatient is conscious, cooperative and well oriented to time, place and person

Vitals:

Pulse : 88 bpm, normal in rate, rhythm, volume and character

BP: 124/86 mmHg, in Right arm supine position

Respiratory rate: 22/min

• Pallor +

• No cervical lymphadenopathy/edema

• No eye signs

Systemic ExaminationCNS: Conscious and oriented, no tremors

CVS: S1 S2 heard. No murmurs

Per Abdomen: Soft, bowel sounds +

RS: Upper Airway : Trachea appears to be in the midline. No stridor

: Lower Airway: B/L air entry is equal. No added sounds

Examination of Neck Inspection:

A swelling of 4X3 cm is visible on the left side of the neck, with well defined borders. Has a smooth surface.

It moves with deglutition

Its lower border is visible

Skin above the swelling appears normal

Examination of Neck Inspection:

A swelling of 4X3 cm is visible on the left side of the neck, with well defined borders. Has a smooth surface.

It moves with deglutition

Its lower border is visible

Skin above the swelling appears normal

Video showing movement with deglutition

Examination of Neck Palpation:

A swelling of 4X3 cm is palpated on the left side of the neck, with well defined borders and smooth surface.

The surface of the rest of the thyroid gland seems to be nodular.

Moves with deglutition

There is no local rise in temperature or tenderness

Kocher’s test ( small swelling, hence not required)

Examination of Neck Palpation:

A swelling of 4X3 cm is palpated on the left side of the neck, with well defined borders and smooth surface.

The surface of the rest of the thyroid gland seems to be nodular.

Moves with deglutition

No local rise in temperature or tenderness

Carotid artery is palpable on both sides equally

No cervical lymphadenopathy

Examination of NeckPercussion:

Percussion over the manubrium gives a resonant note

Auscultation:

No bruit heard over the thyroid gland

SummaryA young lady with slowly progressive swelling in the front of neck on

the left side which is 4x3 cm in size and moves up with deglutition with no features of hypo or hyperthyroidism and no evidence of pressure symptoms or malignancy.

Rest of the thyroid gland is nodular.

DiagnosisOn the basis of the history and clinical examination my diagnosis is:

Multinodular goitre with dominant nodule with clinically euthyroid status in a young lady.