1. Li, Henry Winston Li, Kingbherly Lichauco, Rafael Lim, Imee Loren Lim, Jason Morven Lim, John Harold

2.  65 y/o female  Chief Complaint: Anterior Neck Mass

3. 5 years 2 x 2 anterior neck mass Denies any other accompanying symptom 4 years Progressive increase in size of mass Feel the presence of ‘lump in the throat’ Prescribed L thyroxine 100ug/tab 1 tab TID taken for 1 month Easy fatigability, palpitations, weight loss Consulted again serum T3, T4, TSH measured Advised to discontinue medication Consult Persistence of mass

4.  VS: BP 120/80; PR 85/min; RR 28/min  Pink palpebral conjunctivae, anicteric sclerae  Neck: 8x6 cm firm anterior neck mass with well-defined borders and moves with deglutition, no palpable cervical adenopathies  Heart/Chest/Abdomen – unremarkable

6. Thyroid function test  Serum TSH  T4 and T3

7.  Patient was given L thyroxine 100 ug/tab TID  Possible previous diagnosis:  ↑TSH; ↓T3; ↓T4 = Primary Hypothyroidism  Thyrotoxicosis Facticia  Normal dose: 50-100 ug/tab OD

8.  Goiter - Any enlargement of the thyroid gland  Most nontoxic goiters are thought to result from TSH stimulation secondary to inadequate thyroid hormone synthesis  thyroid gland enlarges in order to maintain the patient in a euthyroid state. Etiology of Nontoxic Goiter Endemic: iodine deficiency, dietary goitrogens Medications: iodide, amiodarone, lithium Thyroiditis: subacute, chronic Familial: hormonal dysgenesis from enzyme defects Resistance to thyroid hormone Neoplasm

9.  Endemic goiters are treated by iodine administration.  Surgical resection is reserved for goiters that  (1) continue to increase despite T 4 suppression,  (2) cause obstructive symptoms,  (3) have substernal extension,  (4) are suspected to be malignant or are proven malignant by FNA biopsy, and  (5) are cosmetically unacceptable.  Subtotal thyroidectomy is the treatment of choice and patients require lifelong T 4 therapy to prevent recurrence.