Identification data - Anterior neck swelling

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