Case history
Case history
At a routine check-up, a 70-year-old woman has an irregularly irregular pulse of 88 bpm and BP of 150/60 mmHg. Neck examination reveals an enlarged thyroid (approximately 30 g) with irregular, bumpy texture. There is no substernal extension, lymphadenopathy, or bruit. The remainder of the examination is unremarkable except for a I-II/VI systolic murmur at the left sternal border and minimal tremor of the outstretched hands. The patient denies heat intolerance or nervousness, but says she has lost a few kilograms over the past year. There is no history of head and neck irradiation. Her aunt had a goitre.
Other presentations
Occasional presenting symptoms are hoarseness, dysphagia, dyspnoea, cough, or a choking sensation caused by neck compression. However, in most patients these symptoms are not caused by apparent thyroid disease, and other aetiologies such as oesophageal disorders, heart disease, or pulmonary disorders should be excluded.[1]
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