INSTRUCTIONS FOR THE DOCTOR
Please take a history and conduct an appropriate examination. Please tell the facilitator your findings and suspected diagnosis.
Jane Matthews is a 31-year-old woman who is pregnant for the first time. She is coming to see you because she has noticed a slight swelling in her neck just below her Adam’s apple.
The following information is on her summary sheet:
INSTRUCTIONS FOR THE PATIENT, JANE MATTHEWS
You are a 31-year-old married hairdresser. You are excited about being pregnant for the first time. Everything has been going well. Last week you were on holiday and you have just been looking at the photos again. Your neck looked a bit odd in the photos and you have now had a closer look in the mirror. There is a smooth swelling in the middle below your Adam’s apple.
You saw your GP last week about the pregnancy and the check-up was fine. You have booked today’s appointment just to sort out the swelling. You are not particularly worried about it.
CLINICAL EXAMINATION FINDINGS
You have a diffuse goitre but no other physical findings or symptoms.
The following information is on your summary sheet:
SUGGESTED APPROACH TO THE CASE
Open-ended questions to explore patient’s ideas, concerns and expectations.
Weight loss, appetite, vomiting, lumps elsewhere
Heat tolerance, energy levels, palpitations, tremor, and difficulty swallowing solids or liquids
Change in voice, change in skin or hair, sweating, sleep pattern
Previous thyroid dysfunction, medications (specifically amiodarone, lithium)
Family history: any family history of thyroid problems, diabetes
Request permission to examine.
Inspection of the swelling
Auscultation of swelling for bruits
Palpation of lymph nodes of the neck
Examination for thyroid signs
— Eyes—for proptosis
— Warmth of peripheries
— General skin changes
There is minor diffuse ...