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Diagnosis?

General Data Name: M, C Age/Sex: 44/Female Civil Status: Married Religion: Catholic Admission: July 11,2017 Chief Complaint: Anterior neck mass HPI: History started 4 years prior to admission, when patient claimed of noticing an anterior neck mass, right, about the size of a marble, moves with swallowing, non-tender, well-delineated and no associated symptoms. No consult nor medication was done during this time. During the interim, patient claimed of a slow, enlargement of the said mass. No associated symptoms. She sought consult and was advised to go to a surgeon. Patient did not comply. 4 months prior to admission, patient claimed that a mass was already present at the left side of her neck w/c was about the same size of the right. Patient also claimed of choking sensation especially when lying supine. Patient decided to seek consult in our institution. Laboratory and imaging tests were requested as well as an FNAB was done. Patient was then advised and scheduled for surgery for which she complied. Past Medical History: Unremarkable Family History: Unremarkable Personal and Social History: Unremarkable Physical Examination: General Survey: conscious, coherent, not in CP distress Vital Signs: BP 100/70 HR 73 bpm RR 20 cpm temp 36.6 C HEENT: Anicteric sclerae, pink conjunctiva; (+) 4cm x 3 cm x 4cm anterior neck mass, right and 3cm x 3cm x 4cm mass at the left, smooth, well-delineated, non-tender and firm, no palpable cervical nodes Chest and Lungs: Symmetrical chest expansion, no rib retraction, clear and equal breath sounds Cardiac: Adynamic precordium, normal rate, regular rhythm, no thrills nor murmurs Abdomen: flat, no post-op scar, normoactive bowel sounds, non-tender Rectal: no anal fissures nor skin tags, good sphincter tone, rectal vault not collapsed, no mass palpated Extremities: full and equal pulses, grossly normal Salient Features: - 44 y.o/female - Slow enlarging anterior neck mass - No other associated symptoms - No family history of thyroid diseases - No history of radiation exposure

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Concluded answer

? Thyroid gland swelling ? Thyroglossal cyst Adv: TFT, USG NECK, FNAC

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Nonspecific cervical adenitis Moving with swallowing probably adherence with thyroid lobes Second possibility lateral accessory thyroid nodules TFT and fnac will help in dx As no significant complaints except nodular swelling in neck Since pt feels compression on trachea or choking suggest either thyroid swelling or lymphadenopathy If usg and fnac are not conclusive go for biopsy

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Nice presentation but have mention about weight gain, irregular periods, cold intolerance etc. Mostly a large MNG with a substernal extension with or without a hypothyroidism. T3 T4 TSH, USG neck and and FNAC atleast from 2 sites required. If an MNG sub total thyroidectomy is plan. In case if patient not willing a thyroid supression therapy can be advised for 6 months like a post op. Case of papillary CA thyroid treated. If the patient is hypothyroidsm and not having a malignant or colloid goitre, there is high chances the size will decrease with time.

SWELLING NECK.. ? THYROID PATHOLOGY.. ? UNDERLYING TISSUE PATHOLOGY.. NEED'S.. X-RAY STUDY.. USG..STUDY.. FNAC HPE..STUDY.. TFT ..

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? Thyroid gland swelling Adv USG guided FNAC

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? Thyroid gland swelling ? Thyroglossal cyst Adv: TFT, USG NECK, FNAC

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Adv CBC,Thyroid profile USG neck and FNAC

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Non specific Cervical Lymphadenopathy