DR GANESH

45 yr , female ,valakkulam swelling over front of neck*2 mnth Noticed a swelling over front of neck No increase in size

H/O heat intolerance, excessive sweating, decreased sleep. No H/O constipation / loose stools noH/O pain /fever noH/O pressure symptoms

Past history : no h/o DM,HTN, CVA, CAD

Personnel history : mixed diet , bowels bladder regular No relevant family history

General ex: pt conscious, cooperative , oriented Moderately built nourished No pallor/ icterus / clubbing / cyanosis / LNE edema PR:72/MIN BP:120/80mmhg

Inspection : A swelling of 7*5cms in front of neck extending from ant border of rt SCM to 1cm medial to lt SCM horizontally. Thyroid cartilage to 2cms above supra sternal notch vertically All borders visible Skin over the swelling normal Surface appears to be regular Moving with deglutition

Palpation: extent rt SCM anterior border to 1cm from lt SCM ant border horizontally vertically from thyroid cartilage to 2cm from supra sternal notch all border can be made out , firm Rt side large nodule with small nodules in lt lobe No palpable lymph node

OTHER SYSTEMS: WNL

Clinical diagnosis :multi nodular goiter

Usg: both lobes of thyroid show multiple nodules rt lobe shows retrosternal extension. FNAC: colloid nodular goiter Free T3:2.82 Free T4:1.17 TSH :0.731

Hb :12.8 Tc: 5,600 Pltelet count: 1.9 lakhs BT: 1MIN RBS: 89mg/ dl Urea:13 Creatinie: 0.7 Na :145 K : 3.9 Serology : negative

Operation:8/6/12 total thyroidectomy Per operative: both lobes enlarged with multiple nodules , isthmus enlarged, no retrosternal extension ,RLN n parathyroids preserved

Post operative :pt stable Se ca+:8.5 :8.1 :8.1 drain removed on POD 3 PT Discharged on POD4

HPR: papillary micro carcinoma T1N0M0= stage1 tumor size: 0.2cm in left lobe rt lobe with MNG with hurthlecell nodules

Med oncolgy consultation: slide&block review to know need for radioablation

PMC Tumor size <10mm Younger , small tumor size pts better prognosis Management : lot of variation follow up with USG , FNAC TSH suppression + radio ablation