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solitary thyroid nodule

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Text of solitary thyroid nodule

  • 1. TOPIC DISCUSSION SolitaryThyroid Nodule CHALINEE WAJANANAWAT

2. Objective 1. Solitary thyroid nodule 2. Solitary thyroidnodule 3. Further Investigation Solitary thyroid nodule4. Solitary thyroid nodule 3. CASE PROFILE Identification data : 52 . . Source of information: Reliability: 4. 5. CHIEF COMPLAINT 2 6. NECK MASS.. IS THAT THYROID GLAND?? 7. 8. Evaluation of thyroid Disease ?

  • History ( family history, history of goiter, local symptoms,
  • symptoms of hyper/ hypothyroidism)
  • Physical examination (general, thyroid gland)
  • Laboratory tests

9.

  • Duration
  • Progression
  • Local symptoms : pain, difficulty in swallowing or breathing,
          • hoarseness
  • Living in endemic goiterarea
  • Family history of goiter, hyperthyroidism, CA thyroid

10. PRESENT ILLNESS 2 . 2 . 11. PAST HISTORY : : : : 12. FAMILY HISTORY : : : 13. PHYSICAL EXAMINATION

  • V / S :T 36 cPR 80/ min
  • RR 16 / minBP 110/60 mmHgBMI22 (W=50/H=160)
  • GA:A middle - aged woman c normalconciousness,
  • no pallor, no jx, no cyanosis,no puffy face
  • Skin : No moist skin, no onycholysis, normal hair distribution
  • Eye : No staring eyes, no lid lag, lid retraction
  • Lung:Normal breath sound, no adventitious sound
  • Heart:Regular, no murmur, symmetrical pulse

14. PHYSICAL EXAMINATION

  • GI:Soft, no mass, no distension, no tenderness,
  • Active BS, Liver & Spleen can not palpable
  • GU: CVA ve, kidney can not palpable
  • Extremities :No edema , no deformity,no tremor
  • no clubbing of fingers
  • Lymph node: can not palpable
  • CNS : WNL,DTR reflex 2+

15. PHYSICAL EXAMINATIONTHYROID GLAND 16. 17. 18. 19. PHYSICAL EXAMINATION NECK : Mass at left neck anterior tosternocleidomastoid muscle Size 4x5 cm. , irregular shape firm cosistency, rough surfaceill-defind border, Not tendermove on swallowing, no bruit 20. 21.

  • Thyroid nodule of left lobe with clinical euthyriod

PROBLEM LIST 22. Am Fam Physician 2003;67:559-66 DIFFERNTIAL DIAGNOSIS 23.

  • Lymphadenopathy
  • Evidence of local invasion
  • -Vocal cord paralysis
  • -Dysphagia
  • Firm, fixed nodules
  • Family history of MEN II
  • Radiation exposure
  • Male
  • Older age
  • Younger age
  • Rapid increase in size
  • Previous thyroid cancer

MAJOR RISK FACTOR. 24. Diagnostic tests

  • Ultrasound
  • Radionuclide scintigraphy
  • Radiography
  • CT and MRI
  • FNA
  • Thyroid function test

25.

  • Can identify presence of nodules.
  • May be able to characterize follicular vs. solid.
  • Evaluated thyroid gland
  • Aid in biopsy.
  • Not able to rule our malignant nodule

Thyroid ULTRASOUND 26. Thyroid Scans

  • Purpose
    • Determine function of the gland and/or a nodule
    • within the gland
  • Hot nodules - usually independently functioning nodules
          • Rarely, rarely malignant
  • Cold nodules - either adenoma or maligancy
          • 15% chance of malignancy in adults.

27. Nuclear Medicine Thyroid Scans Cold Nodule The majority of all nodules Most benign Some malignant Hot Nodule

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