This document summarizes the case of a 35-year-old female presenting with prominent eyes for one year along with palpitations, nervousness, weight loss, and diarrhea. On examination, she displayed signs of thyrotoxicosis including prominent eyes, tremors, and warm moist hands. Laboratory tests revealed hyperthyroidism. She was diagnosed with primary thyrotoxicosis and planned for total thyroidectomy.
This document summarizes the case of a 35-year-old female presenting with prominent eyes for one year along with palpitations, nervousness, weight loss, and diarrhea. On examination, she displayed signs of thyrotoxicosis including prominent eyes, tremors, and warm moist hands. Laboratory tests revealed hyperthyroidism. She was diagnosed with primary thyrotoxicosis and planned for total thyroidectomy.
This document summarizes the case of a 35-year-old female presenting with prominent eyes for one year along with palpitations, nervousness, weight loss, and diarrhea. On examination, she displayed signs of thyrotoxicosis including prominent eyes, tremors, and warm moist hands. Laboratory tests revealed hyperthyroidism. She was diagnosed with primary thyrotoxicosis and planned for total thyroidectomy.
This document summarizes the case of a 35-year-old female presenting with prominent eyes for one year along with palpitations, nervousness, weight loss, and diarrhea. On examination, she displayed signs of thyrotoxicosis including prominent eyes, tremors, and warm moist hands. Laboratory tests revealed hyperthyroidism. She was diagnosed with primary thyrotoxicosis and planned for total thyroidectomy.
Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
You are on page 1of 25
PRIMARY
THYROTOXICOSIS MITHRAAZ 2013 BATCH, KILPAUK MEDICAL COLLEGE, CHENNAI. NAME: MRS. CHANDRA AGE: 35 YRS SEX: FEMALE OCCUPATION: HOME MAKER ADDRESS: KORUKKUPET CHIEF COMPLAINTS PROMINENT EYES for past 1yr HISTORY OF PRESENTING ILLNESS
The patient was apparently normal 1 yr back
after that she noticed prominent eyes. Associated with increased dryness. No h/o itching,redness of eyes or blurred vision. No h/o diplopia H/O loss of weight (15 kgs in one yr) No h/o loss of appetite H/o intolerance to heat H/o excessive sweating • H/o anxiousness and nervousness • H/O tremors • H/o diarrhea on and off episodes, 2-3 times a day, semisolid stools, not blood stained , no mucus, no passage of worms, not fowl smelling. • No h/o vomiting • H/o muscle weakness –difficulty in climbing up stairs. • H/O palpitations • No h/o any swelling • No h/o fever No History suggestive of pressure symptoms like No h/o dyspnoea No h/o dysphagia No h/o change in voice No h/o suggestive of Horner’s syndrome No h/o syncope No History suggesstive of hypothyroidism like No h/o weight gain inspite of poor appetite No h/o constipation No h/o cold intolerance No h/o easy fatiguability NO h/o sudden increase in size No history suggestive of malignancy like: No h/o loss of appetite and weight loss No h/o bone pain No h/o jaundice No h/o cough with hemoptysis No h/o headache, convulsions, seizures PAST HISTORY No h/o similar complaints in the past No h/o previous hospitalisation Not a known case of diabetes , hypertension, asthma , epilepsy, tuberculosis, jaundice , ischaemic heart disease No h/o irradiation No h/o previous surgery No h/o drug intake PERSONAL HISTORY Non – vegetarian diet Patient consumes adequate salt No h/o excessive intake of goitrogens H/o altered bowel habits: diarrhea on and off episodes No h/o altered sleep pattern MENSTRUAL HISTORY Attained menarche at 15yrs of age Irregular cycles for the past 2 yrs, 4/70 days, less flow, not associated with clots or dysmennorhea Last menstrual period:17-10-2017 FAMILY HISTORY No history of similar complaints in the family
ALLERGIC HISTORY No significant allergic history Summary : 35 year old female, came with the complaints of prominent eyes for the past one year, palpitations, nervousness, weight loss inspite of good appetite, diarrhea, oligomennorhea probably involving pathology of thyroid gland. GENERAL EXAMINATION Conscious, oriented Moderately built and nourished No pallor Not icteric No cyanosis No clubbing No pedal edema No peripheral significant lymphadenopathy EYE SIGNS Eyeballs are prominent Dalrymple sign: upper sclera is seen above the limbus Stellwag sign: infrequent blinking of eyelids Von graefe sign: lid lags behind on asking to look up and down Enroth sign: oedema of eyelids and conjunctiva Gifflord sign: difficulty in everting upper eyelid Intention tremors present Hands are warm and moist No pretibial myxoedema, pruritis, palmar erythema, thinning of hair, dupuytren’s contracture. No corneal conjunctival ulcers. VITAL SIGNS BP: 130/80mm Hg measured in left upper limb in sitting posture. Respiratory rate: 17/min thoracoabdominal Pulse rate: 102/min regular in rhythm, normal in volume, no specific character, no radio-radial and no radiofemoral delay,no vessel wall thickening, felt in all accessible peripheral vessels. Temperature:980 F (afebrile) LOCAL EXAMINATION OF THE NECK After getting consent from the patient and explaining her the procedure the patient is examined Examination in the front of neck in the region of thyroid INSPECTION
No visible enlargement in the thyroid region
No visible nodules Surface appears to be smooth Skin over the region of thyroid normal No scar , no sinus, no dilated veins No visible pulsations Trachea appears to be in midline PALPATION
Warm, not tender
Mild diffuse enlargement of thyroid gland Smooth surface No nodules Soft in consistency Moves up on deglutition Does not move with protrusion of tongue Lower border palpable Becomes more prominent on performing pizzilo method Plane of the swelling : deep to deep fascia Carotid pulsation felt against the upper border of thyroid cartilage equal intensity on both sides(Berry’s sign negative) No palpable thrill Trachea is in midline No other swellings present Kocher’s test: no stridor PERCUSSION No retrosternal dullness AUSCULTATION No bruit heard EXAMINATION OF LYMPH NODES No palpable lymph nodes in the neck region. OTHER SYSTEM EXAMINATION: RS: Normal vesicular breath sounds heard, no added sounds CVS: S1 , S2 heard, no murmur CNS : No focal neurological deficit Abdomen :soft, non tender, no organomegaly, no free fluid, hernia orifices free. Spine and cranium normal. DIAGNOSIS A Case of primary thyrotoxicosis INVESTIGATION Baseline investigations : CBC, TC, DC, Hb %,ESR, BT,CT Blood urea, serum creatinine Urine :sugar ,albumin Chest x-ray ECG LFT, RFT Specific investigations • Thyroid profile:TSH,T3,T4,FREE T3, FREE T4 • USG neck • X-ray neck • Sleeping pulse rate • fine needle aspiration cytology. • laryngoscopy • Thyroid stimulating Autoantibodies • Radio active iodine uptake TREATMENT TOTAL THYROIDECTOMY THANK YOU
