Transcript Anterior Neck Mass #2

ANTERIOR NECK MASS #2
Li, Henry Winston
Li, Kingbherly
Lichauco, Rafael
Lim, Imee Loren
Lim, Jason Morven
Lim, John Harold
65 y/o female
 Chief Complaint: Anterior Neck Mass

HISTORY OF PRESENT ILLNESS
• 2 x 2 anterior neck mass
5 years • Denies any other accompanying symptom
• Progressive increase in size of mass
• Feel the presence of ‘lump in the throat’
• Prescribed L thyroxine 100ug/tab 1 tab TID taken for 1
month
4 years • Easy fatigability, palpitations, weight loss
• Consulted again
• serum T3, T4, TSH measured
• Advised to discontinue medication
Consult • Persistence of mass
PHYSICAL EXAMINATION
VS: BP 120/80; PR 85/min;
RR 28/min
 Pink palpebral conjunctivae,
anicteric sclerae
 Neck: 8x6 cm firm anterior
neck mass with well-defined
borders and moves with
deglutition, no palpable
cervical adenopathies
 Heart/Chest/Abdomen –
unremarkable

GUIDE QUESTIONS
1. IF YOU WERE THE PHYSICIAN WHO INITIALLY SAW
THE PATIENT ONE YEAR AGO, WHAT WOULD YOU HAVE
DONE?
Thyroid function test
 Serum TSH
 T4 and T3
2. WHAT DO YOU THINK WERE THE SERUM T3, T4, AND
TSH LEVELS IN THE PREVIOUS CONSULT? WHAT DO
YOU CALL THIS CONDITION?
Patient was given L thyroxine 100 ug/tab TID
 Possible previous diagnosis:

 ↑TSH;

↓T3; ↓T4 = Primary Hypothyroidism
Thyrotoxicosis Facticia
 Normal
dose: 50-100 ug/tab OD
3. WHAT IS YOUR DIAGNOSIS? OTHER
CONSIDERATIONS? EXPLAIN.
Goiter - Any enlargement of the thyroid gland
 Most nontoxic goiters are thought to result from
TSH stimulation secondary to inadequate thyroid
hormone synthesis
 thyroid gland enlarges in order to maintain the
patient in a euthyroid state.

Etiology of Nontoxic Goiter
Endemic: iodine deficiency, dietary goitrogens
Medications: iodide, amiodarone, lithium
Thyroiditis: subacute, chronic
Familial: hormonal dysgenesis from enzyme defects
Resistance to thyroid hormone
Neoplasm
4. HOW WOULD YOU MANAGE THIS PATIENT
NOW?
Endemic goiters are treated by iodine
administration.
 Surgical resection is reserved for goiters that

(1) continue to increase despite T4 suppression,
 (2) cause obstructive symptoms,
 (3) have substernal extension,
 (4) are suspected to be malignant or are proven
malignant by FNA biopsy, and
 (5) are cosmetically unacceptable.


Subtotal thyroidectomy is the treatment of choice
and patients require lifelong T4 therapy to prevent
recurrence.