-swelling of her anterior part of the neck

excessive

-hand sweating of three-month duration

-lately became less

tolerant of hot weather.

problem

-A 38-year old female -middle age,prone to middle age problem/hormonal woman problem - immunocompetent -middle age problem + female such as (cancer ,thyroid, pregnancy)

-swelling of her anterior part of the neck

excessive- swelling of the thyroid gland also lymph node swelling due to infection (anatomical structure of anterior neck/lymph node malignancy)

-hand sweating of three-month duration-hyperhydrosis(primary or secondary,primary-stress,secondary-underlying medical condition,eg-cancer),three month is chronic

-lately became less

tolerant of hot weather.-hormonal endocrine disorder,menopause leads to fluctuation of hormonal level-hyperthyroidism-can increase basal metabolic rate which increases temperature in the body

differential diagnosis

-hyperthyroidism

-thyroiditis-goiter

-cancer

-lymphadenopathy

-trauma

-lymphadenitis-inflammation of lymph node

-thyroglossoduct cyst

-graves disease

-meningitis

further questioning

-socrates;

-site(what specific part of the anterior neck-to differ between lateral or etc),

onset-since when does the swelling start,if sudden then it is likely inflammation

-characteristics-red(how red??oodema??)(radiating or not to differ meningitis or angina)

-associated problems-(hyperhidrosis-irregular heartbaet-difficulty to swallow(problem asssociated hyperthyroidism-increased basal metabolic rate))

-time-episodes of sweating?- 7 days straight to be primary(is it when anxiety to differ anxiety)-day or night(to differ temp related or not)

-exacerbating factor-does pain when taking drugs/eating, painful when swallowing?when eating sppicy food?(hyperhidrosis(induced by capsaicin))(exercising???)

-scale-1 to 10pain or not (to differ severity)

-past medical history-any subsequent trauma injury operation to the neck-any previous medication (have any allergies?)(any comorbidities)(hypertension,diabetes,subsequent throat infection?)

sosial - drugs? smoke? alcohol? where you live? travelling(to differ tropical infection) menstrual cycle (menopause?) occupation, lifestyle/diet/hygiene?

familial history-any family member similar problem cancer? autoimmune disease ,

• lost weight about 11 kg over the past four months, despite having an increased appetite. - due to increase BMR, cause excessive calorie burning leading to lost weight, sleeping difficult due to metabolic changes, hard to relax, symptoms of hyperthyroidism

• She also complained of sleeping difficulty at night - sleeping difficult due to metabolic changes, hard to relax.

• Past medical history no - first onset of sx, acute onset, not chronic situation- can rule out any carcinoma, mayb any cvs ds

• Medications and allergies no - not due to drugs, no past illness, acute, not secondary illness, can rule out any risk factor

• no family history of similar illness - not inherited cancer (less likely to get cancer), can be any sporadic AI ds,

• Social history no - immunocompetent, no risk factor, not due to alcohol or smoking

differential diagnosis

-hyperthyroidism

-thyroiditis-goiter

-cancer

-lymphadenopathy

-trauma

-lymphadenitis-inflammation of lymph node

-thyroglossoduct cyst

-graves disease

-meningitis

further investigation

• BReHeT- bp, hr (maybe high), rr(increase), temp(mayb increase)

• BMI - weight loss (can be due to diet, increase BMR, decrease appetite, calorie deficit, diabetes type 1. adrenal tumor-adrenal insufficiency, pheochromocytoma)

• PE

• inspection, general observation- body habitus, hyperreflexia, neurological examination - muscle weakness,

• palpation of Lymph node (cervical area)- mobile, any mass, pulsatile, solid or liquid, pitting or non pitting

• percussion

• auscultation

• face and neck examination

• eye examination - exophthalmos (if graves ds)

differential diagnosis

-graves disease

-hyperthyroidism

-thyroiditis-goiter

-cancer

-lymphadenopathy

-trauma

-lymphadenitis-inflammation of lymph node

-thyroglossoduct cyst

-meningitis

Further Investigation

• FBC

• TFT

• CT SCAN

• Serum Antibody Titration

• Radioactive iodine uptake

hyperthyroidism due to Graves’ disease