Adenomas, Graves’ Disease, and Thyroid Cancer

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1 What other subjective data would you obtain?
There are many missing or incomplete parts of the subjective data. First, the patient’s demographics are incomplete. The date of birth must be reported to confirm if the age is correct. This is important since the most common age group suffering from neck malignancies is fifty years old and above (CDC, 2020). Conversely, goiter is another disease that must be entertained, and this can be seen in ages forty and above (Mayo Clinic, 2021).
The patient’s place of residence must also be elicited in the general data since the presentation might be secondary to a parasitic or bacterial infection. Specifically, one of the rare parasitic infections that affect the neck is lagochilascariasis. This chronic helminthic infection induces a subcutaneous infection on the neck area, resulting in gradually enlarging mass, associated with pain and neck stiffness, which are similar to the patient’s presentation (Campos et al., 2017).
The chief complaint also lacks details. The patient only said that it was gradual and progressively enlarging for about a year. The location of the swelling should have been identified, and its quality must be described, including the consistency (i.e., soft, hard, firm), initial size and sizes after that, and presence of redness or tenderness. The associated symptoms should also be described. For instance, the area of swelling manifests with pain. If so, this should be described based on the acronym OPQRST, which stands for the onset, palliation or precipitating factors, quality, radiation or relieving factors, severity, and timing (Bickley & Szilagyi, 2012). Other associated symptoms should be described, whether these are pertinent positives or negatives. This is especially important for obstructive symptoms, which might change the course of treatment for the patient (i.e., surgery-requiring masses or aggressive radiation, chemotherapy, or nuclear medicine to reduce the size of the mass or the thyroid gland, respectively). Examples of obstructive symptoms are difficulty swallowing and difficulty breathing. On top of these, exposure to chemicals and radiation is also pertinent in this case (Mayo Clinic, 2021).
For the past medical history, the interviewer only stated “patient denies…” and nothing followed. The interviewer should elicit if the patient had a history of malignancy as the presentation might be secondary to primary cancer or secondary from metastases of primary cancer. Moreover, if the patient had a history of malignancy, this should be evaluated as to where the diagnostics and treatments were previously done. Examples of these are thyroid or salivary gland neoplasms or lymphoma (Pynnonen et al., 2017). Comorbidities should also be included, including cardiovascular, pulmonary, kidney, and other related disorders (Bickley & Szilagyi, 2012).
It should also be prudent to include the size of the breast nodule removed and the complete pathological examination result for the past surgical history. It should also be noted if there are associated complications for the case.
The drug history should determine previous medications taken as some might trigger a metabolic response, such as palpitations and weight loss. Some drugs that might trigger hyperthyroidism are interferon-alpha, amiodarone, alemtuzumab, programmed death receptor-1 (PD-1) inhibitors (such as nivolumab and pembrolizumab), lithium, and excess iodine secondary to increased intake of expectorants (Hershman, 2020).
The obstetric history should also be noted because the disease may be associated with previous gestational disorders. An example of this is hyperemesis gravidarum. Moreover, Grave’s Disease is quite common in pregnant women (Moleti et al., 2019).
Lastly, the review of systems must be done to look for missed symptoms. Examples include insomnia, eye discharges, inflammation, protrusion of the eyeballs, easy fatigability, tremors of the extremities, especially the hands, irritability, heat intolerance, increased sweating, dyspnea, anxiety, nervousness, etc muscle weakness. These may rule out the presence of Graves’ Disease, a condition that affects the thyroid gland (Cleveland Clinic, 2020).
2 What other objective findings would you look for?
It is essential to note the peripheral oxygen saturation for the vital signs to know if the patient might need oxygen supplementation. Also, patients with Graves’ Disease may present with dyspnea. Altho...