OPD

Well hell. Today one 21/Male came with a thyroid swelling and exophthalmos. Initially I thought it was Grave's disease. He did not have palpitations/tachycardia/tremors.He was anxious, but mainly due to the nature of his condition.

On palpating the gland, it was slightly lobular. Smoothly lobular would be more correct, as the curves of the lobules sort of molded into each other. Left side more prominent than right. Trachea slightly deviated to the right. I still thought it was Graves. Mistake number 1.

There was a solitary lymph node palpable in the left supraclavicular fossa. No other relavant findings.

I was about to go to my consultant and think about presenting a case of Grave's, when suddenly this fellow produced an FNAC report done from somewhere in West Bengal. It said "Medullary Carcinoma".

What the fuck man!

On second though Grave's is really diffuse. There shouldn't be any lobules! How will one side be more prominent than the left?

He was also a man with thyroid swelling. That should have set the alarm bells ringing.

Never again will I look at a man with a thyroid swelling and not think of malignancy. Anyway I asked for Routine TFT's, S. Calcitonin, USG Thyroid, Review of his FNAC slide and other routine stuff. I forgot Thyroglobulin. Will do that next time; and won't forget again.