, A 48-year-old woman approached a clinic complaining of productive cough for two weeks but did not report the occurrence of fever, night sweats, or anorexia. She also presented with rapid enlargement of a pre-existing goiter without compressive symptoms.
History Her past medical history included type 2 diabetes mellitus, hypertension, goitre, and primary hypothyroidism for fifteen years. No history of smoking Family history unremarkable Examination Normal body temperature BMI: 35.88 kg/m 2 BP: 120/80 mmHg PR: 89 beats/min RR: 20 breaths/min On auscultation: Normal breath sounds without any rales Cervical examination: Plunging multinodular goitre, without any lymphadenopathy Blood tests Fasting blood glucose of 7.19 mmol/l Plasma creatinine level of 49 μmol/l C-reactive protein level of 5 mg/l (reference range < 5 mg/l) ESR (erythrocyte sedimentation rate) of 57 mm/first hour RBC count…
