The child with a neck swelling
Kayleigh is a 13-year-old girl who has recently noticed a neck swelling. Please examine her.
From the end of the bed, you notice a well-looking teenage girl with an obvious neck swelling.
Introduce yourself. Then ask the child which school and which grade she is in.
- Observe for voice hoarseness (hypothyroidism, larygneal nerve palsy from malignancy)
- Slow speech with hypothyroidism
She looks well-grown and has no obvious scars.
Take a general approach:
- Unwell or well
- Comment on growth and puberty - increased upper segment:lower segment in hypothyroidism
- Vitals - BP, temperature (thyroiditis), HR
- Intellect (hypothyroidism)
- Dysmorphology (Turner, Noonan)
- Lesions of the skin - pre-tibial myxoedema, bruises or petechiae (bone marrow suppression from anti-thyroid treatment)
Also inspect her standing up for:
- Obvious signs: exopthalmos/tremor (hyperthyroidism)
- Scars e.g. thyroidectomy scar (horizontal “necklace” scar). If scar note any voice hoarseness
- Others: facial myxodema/loss of eyebrows/thin hair (hypothyroidism), carotenaemia
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