Click to edit Master subtitle style Case Presentation:

Anterior Neck Mass

4/15/12

History

36 y/o female presents in February 2011 with a multinodular anterior neck mass and complains of odynophagia and bumps in her throat since 2006 Also complains of trouble breathing and swallowing and changes of voice No symptoms of hypo/hyperthyroidism No h/o radiation exposure in the neck Past medical history is positive for Tuberculosis Family history is negative for thyroid disease Denies smoking or drinking alcohol symptoms of blurry vision and irregular

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Physical

Well-developed female in no acute distress Vitals

Temp: BP: 90/60 HR:70

General: Skin is warm and dry HEENT: Normocephalic, atruamatic. Pupils equally round and reactive to light and accommodation. Extra ocular movements intact bilaterally. No exopthalmos. Neck is supple but thyroid has 2 palpable nodules.

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Labs

CBC
WBC Count: 4.6 (normal differential) RBC count: 4.36 H/H: 12.7/40.7%

Endocrine
TSH: .75 Free T4: 1.1 Calcium: 8.6 (low-normal)
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25-Hydroxy Vitamin D: 20.6 (mild deficiency)

Differential
Congenital
Thyroglossal duct cyst

Inflammatory
Viral Lymphadenopathy Bacterial Lymphadenopathy

Neoplastic
Thyroid cancer Lymphoma

Autoimmune 4/15/12

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Source: ACS Surgery: Principles & Practice

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Source: http://www.thyroidmanager.org/chapter18/18-noduletxt.htm

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Papillary Adenocarcinoma

Most common type of thyroid cancer F>M in 30-40 yr age group Main risk factor is family history Metastasis via lymphatic spread Diagnosis via FNA Treatment depends on extent of disease. If < 1.0 cm diameter then hemithyroidectomy can be done. However total thyroidectomy is most commonly done in all cases with lifelong thyroid hormone replacement. Prognosis: Good - 10 year survival rate of 93%

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