As soon as the patient came in, Tao Le could see the difference in her.
This is a girl who looks to be no more than six or seven years old. She is in good spirits. She only has a lump about 2 centimeters in diameter on her chin.
A lump growing in this position could be anything.
Thyroglossal duct cyst, submental chronic lymphadenitis and lymphatic tuberculosis, thyroid adenoma, parotid cleft cyst, thyroid cone lobe, cystic hygroma, lipoma, sebaceous cyst, sublingual cyst, parathyroid cyst, etc.
What it is specifically needs to be identified based on clinical examination.
The girl came in with a woman in her sixties who claimed to be her grandmother.
"The lump on Xiao Meixin's chin appeared more than two months ago. It was the size of a date pit at first. It didn't hurt or itch, and had no impact. We didn't take it seriously at first."
"Then it got bigger and bigger, and my husband got a little worried and asked her to take her to have a look."
"We went to the children's hospital, and when they saw it, they asked us to do a check-up and said it was low T4. They didn't prescribe medicine, but they told us to come back and eat more iodine-containing food."
"As a result, after I ate it, it didn't get smaller at all. Instead, it got even bigger than before."
Grandma said with a frown as she took out the examination slips that had been done at the children's hospital.
Nie Yuan read them one by one and handed them to Tao Le.
Tao Le took over the checklist for the five items of A-Gong and glanced at it. T4 was on the low side, only 3.20ug/dl, and TSH was on the high side, at 7u/L.
T4, also called total thyroxine, refers to the hormone secreted by the thyroid gland, while TSH is a hormone that specifically regulates the synthesis and secretion of thyroid hormone.
The former is low and the latter is high, indicating that the child has hypothyroidism, which is commonly known as "hypothyroidism".
In addition to the indicators, there was another thing that caught Tao Le's attention.
Above the checklist, the child's age is clearly written: nine years old.
Tao Le has worked in the child health department and knows clearly the development standards of a nine-year-old girl.
The girl in front of me is only 1.15 meters tall, which is not very tall among six or seven-year-old girls. She does not look like she is nine years old.
She glanced at the registration information registered in the system. Well, this child is really over nine years old.
This is an obvious developmental delay. Short-term hypothyroidism caused by insufficient iodine intake should not cause such severe developmental delays. unless. ． ． ． ． ．
Naturally, Nie Yuan also thought of the questions she thought of. He signaled Tao Le to do a physical examination on the child.
The child's body temperature was normal, his consciousness was clear, and his breathing was steady. The heart rate was 80 beats/minute, the blood pressure was 89/54mmHG, and there were no rashes or bleeding spots all over the body.
She touched the mass under her neck lightly with her hand. It was hard and the surface was very smooth, making it impossible to push it.
"Make a swallowing motion." Tao Le said gently.
The girl was very obedient and immediately followed the instructions, and the lump moved up and down as she swallowed.
In addition, the child's breathing sounds were clear in both lungs, without rales, the heart rhythm was regular and powerful, and there was no murmur in the precordial area. The abdomen is flat and soft, there is no tenderness in the entire abdomen, the limbs can move freely, the extremities are slightly warm, and the muscle strength is normal.
When she was doing the examination, the patient's grandmother always looked nervous. When she saw her stop, she couldn't help but ask:
"Doctor, look at this thing, it can't be a tumor, right?"
The couple have been worried about their granddaughter's health for a while, worrying about all kinds of things, including the worst kind.
Tao Le did not respond. Deputy Director Nie was there and it was not her turn to speak.
"Family members, you don't have to worry." Nie Yuan's voice was low and steady, which made people feel reassured.
Tao Le was a little envious. Her voice was deep and magnetic, a patent reserved for male doctors. No matter how low she lowered her voice, she could not achieve this effect.
Just listen to Nie Yuan continue to say: "What kind of disease is it? We need to do a comprehensive examination to rule out other diseases and then study it."
Having said this, he looked up at his grandmother with a smile on his face: "But the possibility of tumors growing in this area is very small."
As soon as she said this, the grandmother immediately relaxed a lot, and the girl also had a smile on her face.
The nine-year-old girl is actually very sensible, and this lump seems to have caused her a lot of trouble.
Tao Le felt relieved. This is why Deputy Director Nie has always disliked her, but she still clings to him with all her enthusiasm.
Because from the observations in the past few days, she has discovered that although Deputy Director Nie is usually harsh on her and stern in speech, he does not hesitate to smile and comfort the patients and their families.
It's just that this warmth is usually wrapped in a cold shell, so it's hard to see it easily.
Tao Le already had some guesses in his mind. This girl is probably born with hypothyroidism.
There are many causes of congenital hypothyroidism, such as underdevelopment or underdevelopment of the thyroid gland in children, insufficient iodine intake by the mother during pregnancy, and the presence of immunoglobulins in the body that inhibit the growth of thyroid cells.
In addition, insufficient secretion of pituitary hormones, disorders of thyroxine synthesis, etc. may cause the symptoms of the children at hand.
But if you add that lump. ． ． ． ． There are very few possibilities left.
Tao Le waited for Nie Yuan to issue a checklist to eliminate and judge, but he sat firmly and chatted with the grandmother about household matters:
"How is the child's usual sleep and diet?"
"This child is easy to feed. He has not been picky about food since he was a child. He eats everything he is given and eats a lot." Grandma said, "The same goes for sleeping. He never wakes up until dawn."
"I'm nine years old. I'm in the third grade. Can I keep up with my studies?"
At the mention of this, grandma immediately became excited: "I am in the third grade."
"Her parents have gone out of town since they gave birth to her, leaving the child with us, the old couple." She gushed:
"But she is just sensible and never lets us worry about it. She can finish her homework at school, and she helps with housework, self-study, and reading when she comes home. She makes the old Wang family next door envious to death! That naughty boy in his family, one day If you don’t beat me, go to the house and uncover the tiles..."
Seeing that her topic had strayed, Tao Le quickly helped bring it back: "How are your grades?"
She roughly understood what Nie Yuan meant. Physical growth retardation is often accompanied by low mental development.
No matter how hard you try to be sensible, it still depends on your grades.
"The results are pretty good! The class doesn't care about arranging grades now, but she scored 97 or 80 on the big and small exams. The teachers all like her!"
That means there is no problem with intelligence.
After getting the answer he wanted, Nie Yuan issued a series of checklists.
Tao Le noticed that in addition to the conventional five thyroid function tests and color ultrasound of superficial tumors, static ECT imaging of the thyroid gland and MRI of the pituitary gland were also prescribed.
Grandma took the girl out to pay for the examination. But within a few minutes, they were back.
Tickets for 20 months will receive additional stamps! After the update, there are still two more votes. There are still 18 good votes left before the next update!
Although this book has 600,000 words, compared with the overall length, it is still in the seedling stage and is in urgent need of watering from various monthly votes, recommendation votes, rewards, comments, and full subscriptions! Xiaohai is not good at making something out of nothing. All your support will be transformed into source energy to give birth to fantastic ideas!
(End of chapter)
