THYROID HX.

AND EXAM Name; Esther Kudjo Age; 34yrs Sex; female Occupation;Hair dresser Religion; Christian[Catholic] Residence;Obuasi Brahabebome !; Anterior nec s!ellin"#3yrs H !; $atient !as !ell until 3yrs a"o !hen she noticed a small s!ellin" in the anterior as%ect of her nec !hiles dressin"& 'he re%orted to Obuasi "o()t hos%ital !here she !as "i(en some medications un no!n to her but he condition did not im%ro(e& 'he reali*ed that the s!ellin" !as increasin" in si*e and is no! associated !ith breathlessness+dys%ha"ia but no hoaseness of (oice& 'he decided to re%ort to ath for e,%ert mana"ement& OD" $al%itations%edal s!ellin"# .iarrhoae/ncreased a%%etite0ei"ht lossOli"omenorrhoea/ncreased s!eatin"Cou"h# Chest %ain# Headaches# 1e(erMSH Chronic medical illnesses#[tb+htn+dm+e%ile%sy+ asthma+scd]#(e 2#ray of nec # $re(ious hos%ital admissions# 'ur"ical o%eration# Haemotransfusion# D#ug $x 3on" term medications# Herbal %re%arations# 4o no!n dru" aller"ies %amil& $x 1amily h, of anterior nec s!ellin"# Chronic medical illnesses Social $x 5arried !ith 6 children+ li(e at obuasi !ith family& 'he is a hair dresser&'he eats a lot of cabba"e& 'he neither drin s alcohol nor smo es ci"arettes& S'MMARY / %resent a 34yr old !oman !ho %resented !ith a 3yr history of anterior nec s!ellin" !ith associated %ressure and to,ic sym%toms& /m%ressions

 7ra(es d,8 .iffuse to,ic "oitre 9o,ic multinodular "oitre 9o,ic nodule 9o,ic thyroid adenoma Early sta"e of hashimoto thyroiditis Others#thyroid ca #%retracheal lym%h node #sublin"ual dermoid cyst #thyro"lossal cyst #"oitre O(E Ancious loo in" !oman+ !ho is underdressed for the !eather& 'he is thin& 4ot %ale+ anicteric+ afebrile and !ell hydrated&9rachea is de(iated to the ri"ht& 9here is an anterior nec s!ellin" that mo(es u% !ith s!allo!in" but not !ith %rotrusion of the ton"ue& /t measures 4cm:3cm+ smooth surface+ non tender+ !ell defined ed"es+ firm consistency+not attached to underlyin" structures+s in o(er it mobile+ no differencial !armth+not fluctuant& 4o cer(ical lym%h nodes %al%able& Hands are s!eaty and !arm+ no di"ital clubbin"& 1ine tremors of out hands $ulse ;<b%m+ re"ular "ood (olume and non colla%sin"& B&$ =>?8;< mm of H" !ith a %ulse %ressure of @6mm of H"& '= -'6 -?& 4o lidla"+ no lid retraction+o%hthalmo%le"ia+ chemosis and no e,o%hthalmos& $retibial my,oedemaR(S Air entry adeAuate bilaterally+ breath sounds (ersicular !ith no added breath sounds& )IT Abdomen is soft non tender+ no or"anomelly& 'hiftin" dullnes#(e Bo!el sounds %resent and normal& Hernial orifices clear& !NS Concious and alert+ !ell oriented in %erson %lace and time& $o!er+tone refle,es a%%ear intact& In*estigations Diagnostic 1ree t3+t4+9'H 14AC B'7 of thyroid 2#ray of nec and thoracic inlet .irect and /ndirect laryn"osco%y Supportive 1BC 'ic lin" Brinalysis BB4 Createnine and electrolytes T#eatment Cender %atient euthyroid and do a subtotal thyroidectomy&

9b Carbima*ole =Dm" tid[<hrs btn] Be!are of a"ranulocytosis#sore throat 9b $ro%ranolol 4?m" bd 9b .ia*e%am Dm" bd !omplications o+ su#ge#& Immediate; hemorrha"e hematoma formation Ea#l& ,Ces%iratory obstruction 6nd to %retracheal hematoma 9racheal colla%se Bilateral (ocal cord %aralysis 3aryn"eal oedema 3aryn"eal s%asm #9hyroid storm #Hy%o%arathyroidism[=?mls of =?E calcium "luconate o(er =?min -ate Cecurrence hy%othyroidism Hy%ertro%hic scars Keloid formation External branch of the superior laryngeal nerve which supplies cricothyroid muscle tensor of vocal cord. Cannot sing high pitched notes.