Provisional diagnosis

Provisional diagnosis: simple multinodular goitre

 Points for diagnosis:
o Swellings in anterior part of the neck, large, non tender, irregular, and multinodular
o Swellings are soft and firm consistency and mobile
o Tracheal deviation to the right
o No similar family history
o No symptoms of thyrotoxicosis and pressure effect
 Points against:
o
Differential diagnosis:
1. Grave’s disease
a. Points for diagnosis
i. Swelling in anterior part of the neck
ii. Swelling moves with swallowing not with protusion of tongue
iii. Nodular
iv. Hyperthyroidism symptoms present, such as irritable and palpitations
b. Points against:
i. The swelling is nodular
2. Toxic multinodular goiter
a. Points for diagnosis
i. Swelling in anterior part of the neck
ii. Swelling moves with swallowing not with protusion of tongue
iii. Nodular
iv. Hyperthyroidism symptoms present, such as irritable and palpitations
b. Points against
i. No symptoms of thyrotoxicosis
3. Hashimoto’s thyroiditis
a. Points for diagnosis
i. Swelling in anterior part of the neck
ii. Swelling moves with swallowing not with protusion of tongue
iii. Hypothyroidism symptoms present like cold intolerance, lethargy, mood
swing and weight gain
b. Points against:
i. Swelling has normal temperature
ii. Non-tender swelling
iii. No fever
iv. The swelling is nodular