July 20, 1998
Follow-up of Treated Thyroid Cancer
The patient denies anterior neck pain, tenderness, swelling, dysphagia, odynophagia, hoarseness, dyspnea, cough, or hemoptysis. There has been no chest pain, bone pain, focal muscle weakness or numbness, or any other symptoms suggesting pulmonary, thoracic, skeletal, or neurological metastases.
The patient has had no other complaints of thyroid hormone excess, specifically denying tremor, palpitations, weight loss, heat intolerance, insomnia, hyperdefecation, or unexplained anxiety.
There have been no other symptoms suggesting hypothyroidism, specifically denying cold intolerance, weight gain, constipation, muscle cramps, impaired mentation, or depressed mood.
FH: No new contributory features
SH: Family and work status unchanged. No smoking.
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 relevant clinic notes, laboratory results, and imaging reports, including those ordered by me in advance of this appointment.
Alert and clinically euthyroid. Pain 0/10
Skin warm and dry
HEENT: Eyes: no lid lag or periorbital edema; ENT wnl; carotids full; no JVD
Neck: trachea midline; well-healed thyroidectomy scar; no palpable thyroid tissue, lymphadenopathy, or other 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
Neurological: no Chvostek sign
Papillary thyroid carcinoma, s/p thyroidectomy and radioiodine remnant ablation, on TSH-suppressive thyroxine therapy, with no clinical, laboratory, or radionuclide scan evidence of recurrent disease
Postsurgical hypothyroidism, clinically and biochemically adequately replaced on current thyroxine dose. No evident iatrogenic thyrotoxicosis or under-treated hypothyroidism on this narrow therapeutic index drug.
Continue current L-thyroxine dose pending results of today’s serum TSH and free thyroxine. Patient was reinstructed in elements of proper thyroid hormone treatment, including potential drug interactions, relevant physiological changes, and symptoms suggesting side effects.
Check serum thyroglobulin level on thyroid hormone therapy.
Our findings and recommendations were reviewed in detail with the patient, whose questions were answered as fully as possible.
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