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STRUMA NODUSA
By :
Wina Hanriyani 1102012307
Preceptor :
Dr. HERRY SETYA YUDHA UTAMA, SpB, MHKes,FInaCS
I.
Identity
Name
Age
Gender
Tribe
Occupation
Address
In hospital since
: Ms. S
: 58 years old
: Female
: Javenese
: Gardener
: Kuningan
: December 8th 2016
II.
Anamnesis
Main Grievance
Additional Grievance
III.
chief complaint there is a lump in the neck that are known about 5 years ago. Previous
lumps are small and do not complain of pain, the longer the lump growing.
Pain in the palpable lumps and bumps palpable hard, joined swallowing movements.
Complaints accompanied by heart palpitations and a hoarse voice.
IV.
V.
No family in the neighborhood of patients who have a complaint similar to the patient
VI.
Physical Examination
General Status
Present Status
General Condition
Awareness
Blood Pressure
Pulse
Breathing
Temperature
: Moderate
: Composmentis
: 140/90 mmHg
: 96 x/minute
: 24 x/minute
: 36,4 C
Head
Form
Hair
Eye
: Normal, Simetrical
: Black Colour, No hair fall
: Anemic Conjungtival -/-, Icteric Schlera -/-, Light Refleks (+), Isocorpupil
Ear
Nose
Mouth
right = left
: Normal form, cerumen (-), tympani membrane intac
: Normal form, No septum deviation, epitaction -/: Normal
Neck
Enlargement lymph nodes (-)
Trachea in the middle
palpable masses
Thoraks
Lungs - pulmonary
Inspection
: The chest shape is symmetrical both of left and right
Palpation
: Fremitus tactile and vocal symmetrical right and left, crepitus (-), tenderness
Percussion
Auscultation
Abdomen
Inspection
Palpation
Percussion
Auscultation
Extremity
Upper
: Normal
: Tenderness (-), rebound tenderness (-)
: Tympani
: Bowel (+)
: Muscle Tone
Movement
Mass
Strenght
normal
: active / active
:-/: 5/5
2
Lower
Genitalia
Edema
: Muscle Tone
Movement
Mass
Strenght
Edema
Swelling
: normal
:-/:normal
: active / active
:-/: 5/5
:-/:-/-
Status localist
At the regio colli
Inspection: visible mass in the neck front, the same color with the color
the skin around, rubor (-)
Palpation: mass palpable size 5,6 cm in teh neck. consistency a hard, flat surface, fixed to (+),
pain press (-), blood (-), Pus (-), tracheal deviation is difficult to assess.
Auscultation: bruit (-)
Laboratory Examination
Normal
Diagnosis
Struma Nudosa
Management
-
Prognosis
Quo ad vitam
Quo ad fungsionam
Quo ad sanationam
VII.
: Dubia ad bonam
: Dubia ad bonam
: Dubia ad bonam
Literature Review
Iodine deficiency iodine intake of less than 50 mcg / day. Iodine deficiency is the
most common cause of endemic and sporadic nontoxic goiter.
2.
excess iodine rare and usually occurs in patients with a previous history of
autoimmune thyroid disease.
3.
goitrogens:
- Medication: propilthiouracil (PTU), phenylbutazone, lithium, p-aminosalicylic acid,
aminoglutethimide, sulfonamides,
- Agent environment phenolic derivatives and Phtalate, resorcinol coal.
- Food vegetables (cabbage, cassava), seaweed.
4.Dishormogenesis
What needs to be considered in evaluating patients with non-toxic goitre is a goitre growth
patterns, symptoms of obstruction or compression and cosmetic complaints. There should
also be examined to assess the risk of malignancy.
anamnesis
-
obstruction.
Symptoms of hyperthyroidism may appear gradually
Symptoms of complications: bleeding pain caused by secondary, superior vena cava
Physical examination
-
obstruction
mark-mark thyroid dysfunction:
Hyperthyroidism: not resistant to high temperatures, increased appetite, weight loss,
Malignancy rate
About 5% of struma nodosa undergo malignant degeneration. A careful history and
physical examination raise suspicion toward malignancy of thyroid:
Gender male
History radiation neck region when the child's age - child or adult (also increase the
incidence of benign thyroid nodules)
Here is the algorithm for the evaluation and management of thyroid nodules:
expansion into the chest cavity. Therapy is also indicated if there is a complaint of discomfort
in the neck and cosmetic complaints.
Therapy type
Surgery
profit
Significant reduction of goitre
Loss
risks of surgery
Hypoparathyroidism (1%)
A definitive diagnosis
resection
-
131
L-T4
High cost
Limitations for the use of radioactive
In
fertile
women
in
need
of
contraception
inspiration
low Cost
(low)
-
Thyroiditis (3%)
- Low cost
20%)
- Effectiveness Low
- Treatment of a lifetime
new
- Reduction of 15- 40% in 3 months
Surgical therapy
Goitre surgery can be divided into diagnostic surgery (biopsy) and therapeutic. Surgery in the
form of diagnostic incisional or excisional biopsy had been abandoned, especially after the
more accurate use of fine needle biopsy. Diagnostic biopsy is only done on the state of the
tumor can not be removed, such as in anaplastic carcinoma
A.
Thyroidectomy is the treatment of choice in patients with young and healthy, especially in
cases requiring immediate decompression.
-
Bibliography
1. Hermus AR, Huysmans DA. Clinical manifestations and treatment of nontoxic diffuse
and nodular goiter. In: Braverman LE, Utiger RD, editors. The Thyroid. Philadelphia:
lippincot Williams & Wilkins, 2000. p. 866-70.
2. Lee S. Goiter, nontoxic. Available at: http //: www.emedicine.com.
3. Sjamsuhidajat R, Jong DW. Endocrine system. Textbook of Surgery, revised edition.
EGC 1997; 934-40
4. Hegedu LL, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter:
current status and future prespectives. USA: Endocrine reviews 24 (1): 102-132,
2003. Available at: http //: www.edrv-endojournals.org/pdf
5. MH Wheeler. The technique of thyroidectomy. JR Soc Med 1998; 91 (Suppl. 33) 1216. Available at: http //:www.pubmedcentral.nih.gov,
6. American Thyroid Association. Thyroid disease and pregnancy. Available at: http //:
www. thyroid.org.