BMJ Elective Case Log

This 23 years old woman except myalgia, ocassional cough, fever, and headache was completely alright before march 2015 when she started having loose motion and associated problems such as body pain, headache, skin problem. In 2016, except for loose motion and skin problem, her other symptoms were reduced. Her weight at birth was 1.2 Kg and until 12 years of age she was thin but after that she started gaining weight. She started loosing weight gradually before her first presentation at the opd as she was describing her weight used to be high. Currently being treated as type 1 with insulin since the last 1 and half years. She did tolerate oral hypoglycemics for the first 6 months though. Her mother also got diagnosed as type 2 around the same time ( correction: not around the same time, but her mother developed diabetes shortly a few months after she (our current patient) was diagnosed with diabetes). and her control is worse and she doesn't monitor her sugars regularly either. ...

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here after collecting informed patient consent (form downloadable  Click Here)   by BMJ Elective Student.  This patient's initial clinical details and conversation are posted in detail in this link below: http://736146.blogspot.in/2017/09/operculina-turpethum-3-age-46-y-sex-m.html?m=1 Below are his clinical and radiological images:

This 57 year olf lafy presented with neck swelling, anxiety and tremor. Her medical information is attached below: We need to take a decision on this lady. To operate or not to operate. Now that our clinical suspicions of thyroticosis have been proved and malignancy not proved (not disproved either) what would be the next best step? Medical management for her thyrotoxicosis or still get an excision biopsy with sub total thyroidectomy (and subtotal thyroidectomy other than disproving malignancy will also become treatment for her hyperthyroidism). So which one should we prefer (if the family has no reservations from their side)?

UPDATES FROM HER HOSPITAL ADMISSION DURING THE WINTER OF 2018 Patient history before hospitalization: Presentation notes containing the post hospital intervention part of her history:  Her past full medical records: http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1780 http://globaludhc07.blogspot.in/2016/01/a-40-years-old-woman-with-nasal-tumar.html?m=1 Conversational discussion in Tabula Rasa: Histopathology slides of 40 yrs female with nasal growth. Slides: Dr. Rakesh: Thanks for sharing these DrIshan. You and your team have reported it as Hemagiopericytoma and her previous biopsy from People's 3 years back was Hemangioma. Her complete record and previous discussion in tabula rasa can be found here:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1780 Dr. Rakesh: Currently our surgeon needed to know from the group if we should go for pre...