Journal of Clinical and Diagnostic Research. 2023 Nov, Vol-17(11): YD05-YD07 5 5 DOI: 10.7860/JCDR/2023/65091.18664 Case Report Physiotherapy Section Streamlining Thyroidectomy Treatment with a Multidisciplinary Approach: A Case Report CASE REPORT A 26-year-old married female student of Hindu religion underwent family screening in the Department of Surgery to rule out the presence of MEN2 syndrome. She complained of occasional trouble swallowing and headaches. However, during the screening, a swelling was noticed on the front of her neck. Four months ago, the patient appeared to be in good health. However, during a screening examination, it was discovered that her calcitonin levels were elevated to 2000 pg/mL. The patient reported occasional dysphagia, bilateral frontal lobe headaches, and hair loss. She had no history of dyspnoea or hoarseness of voice. The patient did not have a history of diabetes, hypertension, coronary artery disease, or extended hospital stays, but did have a relevant family history. Her mother had been diagnosed with MEN 2A syndrome with pheochromocytoma and medullary thyroid carcinoma and had undergone bilateral adenectomy with total thyroidectomy. The patient’s two elder brothers had been screened and ruled out. Upon examination, the patient appeared comfortable, conscious, and well-oriented to time, place, and person. She had an average build, normal body temperature, and blood pressure of 110/80 mmHg, a pulse rate of 74 beats per minute (bpm), a respiratory rate of 13 bpm, and an SpO 2 level of 97% in room air. The patient reported no history of pallor, icterus, cyanosis, or clubbing. Chest wall auscultation revealed normal bronchovesicular breath sounds. A local examination focused solely on the neck region showed normal skin colour and texture, with no visible lump. Palpation revealed a 3×4 cm nodule on the left side of the anterior aspect of the neck, which was firm in consistency, non tender, and not fixed to the skin. A systemic examination showed a soft and non tender abdomen, with no palpable masses. The patient had no focal neurological A CECT scan of the neck revealed a large nodule involving the entire left lobe of the thyroid, along with multiple nodules in the right lobe. The CECT scan of the abdomen showed no lesions on the adrenal glands. Additionally, a DOTA NOC scan was performed, suggesting the presence of somatostatin receptor-expressing lesions in both lobes of the thyroid, but no uptake was observed in the adrenal gland. A general neck ultrasound showed a large predominantly solid isoechoic lesion in the left lobe and a small hypoechoic lesion in the right lobe. To confirm the diagnosis, an ultrasound-guided FNAC of the thyroid was conducted, which reported the presence of singly lying and a few small clusters of plasmacytoid cells with abundant cytoplasm and eccentric nuclei showing salt and pepper chromatin, indicative of medullary carcinoma of the thyroid. Therefore, the diagnosis of thyroid cancer with MEN 2 syndrome was established, while parathyroid adenoma and pheochromocytoma were ruled out. Surgical management was planned for the patient, and necessary clearances were obtained from various departments. Total thyroidectomy was performed, along with dissection of the central AVILASH MOHAPATRA 1 , DEEPANSHI VASHISHTHA 2 , SRIKANTA PADHAN 3 Keywords: Physiotherapy, Swallowing strategies, Thyroid cancer, Vocal cord palsy ABSTRACT Multiple Endocrine Neoplasia 2 (MEN2) is a rare genetic disorder that affects the endocrine glands and can lead to the development of tumours in the thyroid gland, parathyroid gland, and adrenal glands. Individuals with all subtypes of MEN2 syndrome {MEN2A, MEN2B, and familial Medullary Thyroid Cancer (MTC)} are at an increased risk of developing MTC. In the present case report, authors present the case of a 26-year-old female who presented to the Department of Surgery for family screening due to her mother’s diagnosis of MEN 2A syndrome. During the screening, a swelling was identified in the anterior neck region. The swelling was firm, non tender, and not fixed to the skin. Additionally, the patient had an elevated calcitonin level. Although the patient had no history of voice abnormalities, she occasionally experienced dysphagia. A Contrast-enhanced Computed Tomography (CECT) scan of the neck revealed involvement of both lobes of the thyroid gland. To confirm the diagnosis, a DOTA NOC scan (an imaging procedure involving the injection of a radiotracer dye known as DOTA and NOC, followed by Positron Emission Tomography (PET) or Computed Tomography (CT) scan and ultrasound-guided Fine Needle Aspiration Cytology (FNAC) of the thyroid were conducted. Based on the confirmed diagnosis, the patient underwent surgical management in the form of total thyroidectomy and central compartmental lymph node dissection. However, postoperatively, the patient experienced difficulty in speech and swallowing due to involvement of the Recurrent Laryngeal Nerve (RLN). These issues were managed through physiotherapy and speech therapy as part of a holistic approach, which proved to be crucial in improving the patient’s condition and preventing complications. Therefore, the management of thyroidectomy should adopt a patient-centric and multidisciplinary approach to enhance patient outcomes and minimise complications. Blood parameters Values Haemoglobin (gm/dL) 12.6 Total serum bilirubin 1.2 SGOT 12 SGPT 21 Creatinine (mg/dL) 0.5 [Table/Fig-1]: Routine blood investigation values. SGOT: Serum glutamic-oxaloacetic transaminase; SGPT: Serum glutamic pyruvic transaminase deficits, and their higher mental functions were intact. Routine blood investigations were conducted as shown in [Table/Fig-1].