Euthyroid Multinodular Goitre :Curofy Expert Clinical Case Discussion by Dr. Krishnan Pichumani: A case with unusual features & with good learning experience

Every clinical case doesn't always require extensive treatment. Treatment of many cases is determined by several factors related to patient's safety & such cases are quite manageable by simple management. Learn about this case of Euthyroid Multinodular Goitre by Dr. Krishnan Pichumani Enhance your clinical knowledge by learning thorough his rich experience. Follow us for more such updates

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Very nicely presented this case of A Euthyroid Multi - nodular Goiter with gross enlargement of left lobe of thyroid with retro - sternal extension with mass effect on trachea and lower esophagus. Considering mass effect - a thyroidectomy is indicated. Had patient been younger, this should have been done - but since patient is 77 years of age - patient 's relatives have rightly refused surgical intervention as risk of surgery is more - considering patient is asymptomatic and it is a benign disease. Although potential of its conversion to Anaplastic carcinoma is there - but for that regular yearly follow up is enough

Thank you ,Sir, for your valuable opinion.
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We were taught by our professor in medical college that you sitting in an institution having facility of malaria test a thermometer and stethoscope and by clinical examination and through history In chronological order ,you have to make provisional diagnosis and than diagnosis and treatment plan should be made in such a way that minimum medicine available in institution given to pt and hope he or she will be cured without any further investigation ( not available in that period ) . I am proud to say we have completed more than 35 yrs in service without much change in my attitude. Case discussed above by all respected colleagues is a clear example that man mind created tests and clinical machine to help them not to dictate them. Best example despite of all resources entire world put their knees down to Corona pandemic. More than one year has already been elapsed but no vaccination or cure available. Intresting case share by my colleague and exactly and honestly discussed by all.

Thank you, Dr Ashok Leel, you have hit the nail on the head. Whatever technological advances are in medical sciences, human brain is going to be most crucial instrument in diagnosis and management.
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Nicely presented case. We see such cases and try to over treat so many times. Good lessons to learn. Euthyroid Multinodular goitre... with mass effects requires surgical treatment ... but advanced age is reason for not doing heroics ... Needs to review frequently is need of time for this patient...

Thank you,Dr Gaurav Chhaya ,for your neat summation of this case. Purpose of presentation of this case is served.
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NICE ILLUSTRATSTION CLINICALLY IF ONE HAS A MODULE IN THRIOD DD ADENOMA THRIOD SINGLE NODULE OF A MULTINODULAR GOITER PAPPILEFEROUS CARCINOMA OF THRIOD

Thank you ,Dr Gowhar Ahmad
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Good case. Reported xray in the morning

Thank you,Sir
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Very helpful presentation doctor.

Thank you, Dr Muskan Makandar
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Nice n informative

Thank you ,Dr Naz Khan
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Nice posting sir

Thank you, Dr Ramesh Kumar Singh, I have always admired you for your robust clinical sense in your replies
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Nice post

Thank you ,Dr Sabista Naaz
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Sir I have a Case 61-year-old female patient had no concomitant morbidity, no past history (surgical or medical), and no relevant family medical history. The patient presented with a huge neck swelling that was interfering with her normal movements, and which she complained was giving her a sense of tightness and heaviness.The patient first noticed the goitre 40 years ago, which gradually progressed in size, but with no obstructive or compressive symptoms. The goitre measured approximately 2 7 × 2 3 cm in its largest dimensions and displayed multidirectional enlargement: anteriorly, where it was pendulous over the sternum; posteriorly; superiorly, to the mandible and floor of the mouth; and inferiorly, where the lower border or edge of the goitre could not be palpated (suggesting substernal extension). A thyroid hormone profile confirmed the euthyroid status of the patient during routine preoperative tests. Although we considered the possibility of malignancy, no logistic medical facilities were available to aid in diagnosis such as the fine needle aspiration cytology (FNAC).

Thank you ,Dr Manoj Kumar ,for your interesting case. Fortunately the enlargement of this thyroid mass has been external, without causing compression on trachea and oesophagus. It is euthyroid. At age 61, surgical risk of removal of such huge mass may be high, depending on comorbidities. Unless patient demands removal, conservative management can be done. FNAC is simple ,economical and in thyroid masses is very reliable. Worth doing FNAC
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