70 years old, lady, complained of difficulty in swallowing and shortness of breath for the past 5 months with an anterior neck swelling for the past 20 years. 5 months ago she notice that the swelling starts to grow more rapidly compared to previous years. Patient also complains of hoarseness of voice, loss of appetite, loss of weight roughly around 6 kg and pain at the swelling.
a) State the abnormality seen in this photograph.
b) State FOUR (4) clinical signs you would want to elicit in this patient.
c) State TWO (2) tests to assess the anatomical origin of the swelling.
d) State the most likely diagnosis.
e) Explain the cause of hoarseness of voice in this patient.
f) List THREE (3) investigations you would like to do and give reason for each.
g) Patient had undergone total thyrodectomy the next day. what you would like to prescribe for patient post-op
The answers:-
a) bilateral anteror neck swelling
b) Fine tremor
Lid lag
Lid retraction
Exopthalmus
Fine tremor
Brisk reflex
Tachycardia
Clubbing (thyroid acropatchy)
Carotid bruit
Stridor
Raised BP
c) Tongue protrusion test
Swallowing test
d) Thyroid ca secondary to long standing MNG
e) Compression of recurrent laryngeal nerve from vagus nerve
f) Thyroid function test - to assess thyroid status
FBC - to asess anemia
ECG - hyperthyroid may cause arrythmia
Neck X-Ray - To assess retrosternal extension
CT scan - to assess extension of thyroid mass
FNAC of swelling - To confirm thyroid ca
g) L-thyroxine
Calcium gluconate
Vitamin D supplement
