JOHNS HOPKINS -cancer.net



New Thyroid Nodule Patient

New consultation at the request of Dr_______________

The patient denies anterior neck pain, tenderness, swelling, dysphagia, odynophagia, hoarseness, cough, hemoptysis, or dyspnea.  There has been no chest pain, bone pain, focal muscle weakness or numbers, or any other symptoms suggesting pulmonary, thoracic, skeletal, or neurological metastases.

 The patient has had no complaints of thyroid hormone excess, specifically denying tremor, palpitations, weight loss, heat intolerance, insomnia, hyperdefecation, or unexplained anxiety.  There have been no symptoms suggesting hypothyroidism, specifically denying cold intolerance, weight gain, constipation, dry skin, muscle cramps, impaired mentation, or depressed mood.

The patient denies flushing, diarrhea or itching suggesting hypercalcitoninemia.  There is no personal or family history of hypercalcemia, renal stones, or hyperparathyroidism; severe, labile or poorly controlled hypertension, adrenal tumor, or pheochromocytoma; or other feathers of the MEN 2a or 2b syndromes.

There is no history of childhood neck irradiation.

There is no known family history of thyroid disease or, as noted above, or features suggesting the MEN 2 syndromes.

The patient’s general health since the last visit has otherwise been good. Review of all other systems is negative.

I reviewed the patient’s previous medical records today, including previous relevant clinical notes, laboratory results, and imaging reports.

Alert and clinically euthyroid.

Skin warm and dry

HEENT: Eyes: no lid lag or periorbital edema; ENT wnl; carotids full; no JVD

Neck: trachea midline; thyroid gland: …..; no cervical lymphadenopathy in the central, lateral or posterior compartments; no other palpable cervical mass.

Chest: clear to percussion and auscultation

Heart: PMI MCL, S1 normal, S2 physiologically split; no gallop, murmur or rub.

Abdomen: no organomegaly or masses

Ext: no tremor, normal deep tendon reflexes, normal muscle strength, no edema.

Thyroid nodule, no clinical features suggesting local compressive symptoms, thyrotoxicosis, or malignancy

Continue conservative observation. The patient was reminded of symptoms or signs that might indicate thyroid nodule enlargement and asked to contact me in the event that these developed before the next scheduled appointment. The patient was given the opportunity to ask questions, and these were all answered as fully as possible.

In the event that cytological findings are not indicative of a malignant or suspicious lesion, conservative observation will be recommended.  The patient was reminded of symptoms or signs that might indicate thyroid nodule enlargement and asked to contact me in the event that these developed before the next scheduled appointment.  The patient was given the opportunity to ask questions, and these were all answered as fully as possible. 

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