Rule in Rule out Add lab

Primary Impression

Non-Toxic Goiter (Diffuse) age sex neck mass none none

Painless goiter

Differential diagnosis

Hashimotos disease age sex neck mass t4 t3 tsh autoantibodies test

Painless goiter

Subacute thyroiditis age sex goiter painful goiter increase t3 t4 esr cbc fnab
Increase wbc

Silent thyroiditis age sex painless goiter increase t3 t4 normal vital esr crp
Easy fatiguability signs

Graves disease sex age neck mass increase t3 t4 dec tsh auto antibodytest (tbII)
Ft4 assays

Non-toxic goiter multinodular age sex euthyroid brown gelatinous colloid mri/ct pulmon
Anterior neck mass ary functiontest

Thyroid lymphoma age sex enlarged dec tsh fever wt loss fnab cbc
Enlarged thyroid fnab(enlarged lymph nodes)
Easy fatigue

Thyroid Cancer

Papillary thyroid carcinoma age sex easy fatigue atypical cell fnab ultrasound
Neck mass

Riedels thyroiditis gender age neck mass fibrosis esr incision biopsy
No pain calcium level

Labs eprformed on patient ibutang sa labs:

Thyroid function test fnab

Cbc ultrasound.
 patient normal interpretation/necessity cost

Cbc

Hgb 13.3gm% 12-14gm%

Hct 38% 37-44%

Wbc 7.260/cumm 4.5-11T/cumm

Thyroid
function
TesT

Total t3 0.96ng/ml 80-180ng/dl

Total t4 7.38ug/ml 4.6-12ug/dl
Ft3 1.06 pg/ml 230-619pg/dl
Ft4 0.88pg/dl 0.7-1.9ng/dl
Tsh 0.850IU/ml 0.34-4.25IU/ml

Ultrasound

Right lobe: 3.4cm ap dimension With mass measuring 3x2.8x3.6 16.2 volume
Left lobe: 3.1cm ap dimension with mass measuring 2.7x2.8x3.8

Fine needle aspiration biopsy

Microscopic examination of smears shows a thin film of colloid with a few randomly scattered rbc and
inflammatory cells. The latter include occasional histiocytes. Colloid material is scanty and mostly seen
at the edges of the smears. Randomly scattered throughout the smears are several benign follicular
epithelial disposed in small loose clusters. These have pale cytoplasm surrounding uniform round to oval
finely granular nuclei without atypia.