Subjective:

Chief Complaint: Enlarging anterior neck mass.

History of Present Illness:

4 months prior to consultation, the patient had anterior neck mass, more in the right originally
measured 2 cm and has now increased to 5 cm in size. No associated hyper or hypothyroid symptoms
noted.

Objective:

Physical Examination:

Upon examining, stable vital signs Enlarging anterior neck mass located anterolateral to the trachea,
moving with deglutition. No cervical lymphadenopathy noted on palpation.

Review of system:

General: Recent weight change (enlarging neck mass could potentially affect weight), No weakness,
fatigue, or fever.

Neck: Enlarging anterior neck mass, which is the chief complaint, No neck pain or stiffness.

Respiratory: No cough or dyspnea, No pleuritic pain or wheezing.

Cardiovascular: No orthopnea or paroxysmal nocturnal dyspnea. No edema or chest pain/discomfort.

Endocrine: No heat or cold intolerance. No excessive sweating, thirst, or hunger.

Diagnostic Workup and Results:

Serum thyroid hormones: FT4, FT3, and TSH were all normal.

Thyroid ultrasound: Revealed a 3.5 cm TIRADS 4 mass encompassing the right thyroid, along with lymph
nodes in levels 3 and 4.

Fine needle aspiration biopsy (FNAB) of the thyroid nodule: Revealed Bethesda category V results
suspicious for papillary thyroid carcinoma.

Biopsy of level 3 lymph node: Revealed thyroid cells, probably metastatic carcinoma.

Total thyroidectomy with MRND Type III: Revealed a high-grade papillary thyroid carcinoma with a
hobnail type.

Assessment:

Differential Diagnosis:

Papillary thyroid carcinoma: Supported by FNAB results and histopathology findings.

Nodular non-toxic goiter: Initially considered due to the presence of an enlarging neck mass, but ruled
out based on subsequent investigations.

Final Diagnosis: High-grade papillary thyroid carcinoma with lymph node metastasis.
Plan:

Postoperative radioactive iodine (RAI) therapy due to the patient's high AGES score.

Initiation of levothyroxine for TSH suppression.

Regular follow-up every 6 months for serum thyroglobulin monitoring and neck ultrasound.