CHIEF COMPLAINT: large compressive substernal thyroid goiter

PRESENT ILLNESS: 88-year-old female who has been diagnosed with a very large
thyroid goiter, which is compressing both her trachea and her
esophagus.  This has resulted in her being unable to eat; and
due to breathing problems, she has a tracheostomy. She has a 6.7
x 5.2 x 8 cm heterogeneous mass originated from the right
thyroid gland.  It extends below the thoracic inlet.  She was
found to have marked leftward shift of the trachea with
narrowing from approximately 11 mm to 7 mm.  There is
displacement of the brachiocephalic vein and the branch vessels
of the aortic arch anteriorly.  She presents for surgical
removal of the thyroid mass.

MEDICAL HISTORY: Subarachnoid hemorrhage s/p coiling of R PCA aneurysm
Hydrocephalus s/p VP shunt
Respiratory failure requiring trach placement
Thoracic mass: biopsied - benign thyroid nodule
Hyperthyroidism with goiter secondary to amiodarone toxicity
Anemia - prior black stools with no source found from
EGD/c-scope
Deep vein thrombosis s/p IVC filter
Hypertension
Atrial fibrillation

MEDICATION ON ADMISSION: albuterol nebs prn, atrovent nebs prn, lansoprazole 30',
levetiracetam 100mg/mL soln 15mL via PEG tube [**Hospital1 **], methimazole
15mg daily, tylenol prn, aspirin 81', ferros sulfate 300mg/5mL
liquid 5mL PEG tube [**Hospital1 **], colace 60mg/15ml syrup 60 mg [**Hospital1 **],
guaifenesin 100mg/5mL liquid 10mg PEG q6 prn

ALLERGIES: Lactose

PHYSICAL EXAM: 98.4, 76, 110/75, 15, 100% on trach mask
neck incision clean and dry with staples, bacitraicin to site
mild edema along skin flap, improving
trach in place with collar, sutures in place
PEG tube in place, no abnormal drainage or surrounding erythema
lungs clear bilaterally, coarse at times
heart is irregularly irregular, rate normal
minimal peripheral edema

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: living at home with supportive daughters prior to admission, had
been at [**Hospital3 **] for extensive stay after prolonged
hospitalization, currently not able to walk, but had previously
been able to walk with a cane or walker
no tobacco or alcohol use
Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Presence of cerebrospinal fluid drainage device,Attention to tracheostomy,Atrial fibrillation,Dysphagia, unspecified,Edema,Anemia, unspecified,Unspecified essential hypertension,Osteoporosis, unspecified,Personal history of venous thrombosis and embolism,Gastrostomy status,Cardiac rhythm regulators causing adverse effects in therapeutic use
Tox dif goiter no crisis,Ventricular shunt status,Atten to tracheostomy,Atrial fibrillation,Dysphagia NOS,Edema,Anemia NOS,Hypertension NOS,Osteoporosis NOS,Hx-ven thrombosis/embols,Gastrostomy status,Adv eff card rhyth regul
Admission Date:  [**2181-4-16**]              Discharge Date:   [**2181-4-20**]


Service: CARDIOTHORACIC

Allergies:
Lactose

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
large compressive substernal thyroid goiter

Major Surgical or Invasive Procedure:
right hemithyroidectomy, resection of substernal goiter


History of Present Illness:
88-year-old female who has been diagnosed with a very large
thyroid goiter, which is compressing both her trachea and her
esophagus.  This has resulted in her being unable to eat; and
due to breathing problems, she has a tracheostomy. She has a 6.7
x 5.2 x 8 cm heterogeneous mass originated from the right
thyroid gland.  It extends below the thoracic inlet.  She was
found to have marked leftward shift of the trachea with
narrowing from approximately 11 mm to 7 mm.  There is
displacement of the brachiocephalic vein and the branch vessels
of the aortic arch anteriorly.  She presents for surgical
removal of the thyroid mass.

Past Medical History:
Subarachnoid hemorrhage s/p coiling of R PCA aneurysm
Hydrocephalus s/p VP shunt
Respiratory failure requiring trach placement
Thoracic mass: biopsied - benign thyroid nodule
Hyperthyroidism with goiter secondary to amiodarone toxicity
Anemia - prior black stools with no source found from
EGD/c-scope
Deep vein thrombosis s/p IVC filter
Hypertension
Atrial fibrillation


Social History:
living at home with supportive daughters prior to admission, had
been at [**Hospital3 **] for extensive stay after prolonged
hospitalization, currently not able to walk, but had previously
been able to walk with a cane or walker
no tobacco or alcohol use

Family History:
noncontributory

Physical Exam:
98.4, 76, 110/75, 15, 100% on trach mask
neck incision clean and dry with staples, bacitraicin to site
mild edema along skin flap, improving
trach in place with collar, sutures in place
PEG tube in place, no abnormal drainage or surrounding erythema
lungs clear bilaterally, coarse at times
heart is irregularly irregular, rate normal
minimal peripheral edema

Pertinent Results:
[**2181-4-16**] 01:28PM BLOOD Glucose-117* UreaN-17 Creat-0.8 Na-144
K-3.9 Cl-106 HCO3-28 AnGap-14
[**2181-4-17**] 01:37AM BLOOD Glucose-141* UreaN-17 Creat-0.8 Na-140
K-4.4 Cl-105 HCO3-26 AnGap-13
[**2181-4-18**] 06:40AM BLOOD Glucose-102* UreaN-15 Creat-0.9 Na-137
K-4.0 Cl-103 HCO3-27 AnGap-11
[**2181-4-19**] 06:30AM BLOOD Glucose-105* UreaN-12 Creat-0.8 Na-140
K-4.0 Cl-106 HCO3-26 AnGap-12
[**2181-4-20**] 06:00AM BLOOD Glucose-87 UreaN-13 Creat-0.8 Na-139
K-4.2 Cl-105 HCO3-29 AnGap-9

[**2181-4-16**] 01:28PM BLOOD Albumin-2.9* Calcium-8.5 Phos-3.1 Mg-1.7
[**2181-4-17**] 01:37AM BLOOD Albumin-3.0* Calcium-8.4 Phos-4.0 Mg-2.3
[**2181-4-17**] 09:00AM BLOOD Albumin-2.8* Calcium-8.2* Phos-3.6
[**2181-4-18**] 06:40AM BLOOD Albumin-2.8* Calcium-8.5 Phos-3.3 Mg-1.9
[**2181-4-19**] 06:30AM BLOOD Albumin-2.9* Calcium-8.2* Phos-3.3 Mg-2.1
[**2181-4-20**] 06:00AM BLOOD Albumin-3.0* Calcium-8.5 Phos-3.6 Mg-2.0

[**2181-4-16**] 01:28PM BLOOD WBC-7.0 RBC-2.24*# Hgb-6.9*# Hct-22.0*#
MCV-98 MCH-31.1 MCHC-31.6 RDW-15.7* Plt Ct-329
[**2181-4-16**] 05:24PM BLOOD WBC-8.3 RBC-2.97*# Hgb-9.1*# Hct-27.9*#
MCV-94 MCH-30.5 MCHC-32.5 RDW-17.2* Plt Ct-325
[**2181-4-17**] 01:37AM BLOOD WBC-7.4 RBC-2.82* Hgb-8.8* Hct-26.9*
MCV-96 MCH-31.1 MCHC-32.6 RDW-17.3* Plt Ct-302
[**2181-4-18**] 06:40AM BLOOD WBC-7.8 RBC-2.52* Hgb-7.9* Hct-24.0*
MCV-95 MCH-31.2 MCHC-32.9 RDW-16.2* Plt Ct-324
[**2181-4-19**] 06:30AM BLOOD WBC-6.1 RBC-2.60* Hgb-7.8* Hct-24.7*
MCV-95 MCH-30.2 MCHC-31.8 RDW-15.6* Plt Ct-327
[**2181-4-20**] 06:00AM BLOOD WBC-5.8 RBC-2.69* Hgb-8.2* Hct-26.1*
MCV-97 MCH-30.6 MCHC-31.5 RDW-15.5 Plt Ct-350

Brief Hospital Course:
Ms. [**Known lastname **] was taken to the operating room with Dr.
[**Last Name (STitle) 1837**] and Dr. [**Last Name (STitle) **] for right hemithyroidectomy,
substernal goiter resection. She tolerated the procedure and was
transferred to the ICU still extubated. Her postop hematocrit
was 22 and she was given a unit of blood, bumping to 27.
Endocrinology was consulted who recommended following q8 hour
calcium, phosphorus, and albumin labs and decreasing the
methimazole dosing to 5mg daily. On POD 1, the patient was
extubated and weaned to trach collar without difficulty.
Methimazole was stopped completely per endocrine. Her tube feeds
were started via PEG which she tolerated without difficulty,
advanced to goal by POD 2.The labs remained within normal limits
with hematocrit stabilized at her baseline, requiring no further
transfusions. The trach sutures were loosened at the bedside on
POD 1 as well as to prevent flap necrosis secondary to
postoperative edema of the flap. Her foley, central line, and
a-line were removed. She was incontinent of urine. She was
transferred to the floor. On POD 2, her L JP drain was removed
without incident. She failed speaking valve trial with speech
and swallow. R JP was removed on POD 3. She was on unasyn
throughout her stay for perioperative coverage and was
transitioned to augmentin for three more days at the time of
discharge. She required aggressive suctioning by nursing, but
otherwise was stable from a cardiorespiratory standpoint
throughout her admission. She was cleared for discharge to rehab
on POD4. She had new baseline thyroid function tests sent that
morning, and will be followed up after discharge. She will
follow up with ENT surgery in 1 week for staple removal. She
will follow up with her endocrinologist in a routine fashion.

Medications on Admission:
albuterol nebs prn, atrovent nebs prn, lansoprazole 30',
levetiracetam 100mg/mL soln 15mL via PEG tube [**Hospital1 **], methimazole
15mg daily, tylenol prn, aspirin 81', ferros sulfate 300mg/5mL
liquid 5mL PEG tube [**Hospital1 **], colace 60mg/15ml syrup 60 mg [**Hospital1 **],
guaifenesin 100mg/5mL liquid 10mg PEG q6 prn

Discharge Medications:
1. Augmentin 250-62.5 mg/5 mL Suspension for Reconstitution [**Hospital1 **]:
17.5 mL PO twice a day for 3 days: give via PEG tube.
2. heparin (porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
injection Injection [**Hospital1 **] (2 times a day).
3. ferrous sulfate 300 mg (60 mg iron)/5 mL Liquid [**Hospital1 **]: Three
Hundred (300) mg PO DAILY (Daily).
4. oxycodone 5 mg/5 mL Solution [**Hospital1 **]: 2.5 mg PO Q4H (every 4
hours) as needed for pain.
5. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Hospital1 **]: One (1) neb Inhalation Q6H (every 6 hours).
6. levetiracetam 100 mg/mL Solution [**Hospital1 **]: 1500 (1500) mg PO BID
(2 times a day).
7. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
8. docusate sodium 50 mg/5 mL Liquid [**Last Name (STitle) **]: One Hundred (100) mg
PO BID (2 times a day).
9. latanoprost 0.005 % Drops [**Last Name (STitle) **]: One (1) Drop Ophthalmic HS (at
bedtime).
10. bacitracin zinc 500 unit/g Ointment [**Last Name (STitle) **]: One (1) Appl
Topical [**Hospital1 **] (2 times a day).
11. senna 8.8 mg/5 mL Syrup [**Hospital1 **]: One (1) Tablet PO BID (2 times
a day).
12. insulin sliding scale
insulin sliding scale per protocol at rehab, patient on tube
feeds
13. general
PLEASE GIVE ALL MEDS VIA PEG TUBE, NO PO MEDS, PATIENT TO BE
STRICT NPO UNTIL FOLLOW UP OUTPATIENT SPEECH AND SWALLOW
EVALUATION
14. acetaminophen 650 mg/20.3 mL Suspension [**Hospital1 **]: Six Hundred
Fifty (650) mg PO every 4-6 hours as needed for pain.
15. Tube Feeds
Replete with fiber 1/2 strength at 50cc/hour via PEG tube
Flush w/ 100 ml water q6h
Do not give pills via PEG if can be avoided, prefer liquid
medications to prevent difficulty with tube


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
substernal goiter


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Lethargic but arousable.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You will be going to a rehab facility to continue recovering
from your surgery. Your rehab should continue placing trach
sponges underneath the collar to support your trach and protect
your surgical skin flap. You will have the staples in place
until one week after discharge when you will see Dr.
[**Last Name (STitle) 1837**] in the office and have them removed.

You will continue on tube feeds and your home medications. YOU
WILL NO LONGER BE TAKING METHIMAZOLE SO MAKE SURE TO STOP THAT
MEDICINE. You will need to take three more days of antibiotics.

You should continue to take nebulizers and have aggressive chest
physical therapy at your rehabilitation to prevent pneumonia.
You should be out of bed as much as possible with assistance.

Followup Instructions:
[**First Name4 (NamePattern1) 177**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 41**] Date/Time:[**2181-4-27**]
4:15
([**Telephone/Fax (1) 6213**] Office Location:
[**Last Name (NamePattern1) **], [**Hospital **] Medical Office Suite 6E

Please call Dr. [**Last Name (STitle) **] with endocrinology to schedule routine
outpatient follow up. [**Telephone/Fax (1) 1803**]

Provider: [**First Name8 (NamePattern2) **] [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 3445**], MD Phone:[**Telephone/Fax (1) 2574**]
Date/Time:[**2181-5-11**] 2:30



Completed by:[**2181-4-20**]
{'Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Presence of cerebrospinal fluid drainage device,Attention to tracheostomy,Atrial fibrillation,Dysphagia, unspecified,Edema,Anemia, unspecified,Unspecified essential hypertension,Osteoporosis, unspecified,Personal history of venous thrombosis and embolism,Gastrostomy status,Cardiac rhythm regulators causing adverse effects in therapeutic use'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: large compressive substernal thyroid goiter

PRESENT ILLNESS: 88-year-old female who has been diagnosed with a very large
thyroid goiter, which is compressing both her trachea and her
esophagus.  This has resulted in her being unable to eat; and
due to breathing problems, she has a tracheostomy. She has a 6.7
x 5.2 x 8 cm heterogeneous mass originated from the right
thyroid gland.  It extends below the thoracic inlet.  She was
found to have marked leftward shift of the trachea with
narrowing from approximately 11 mm to 7 mm.  There is
displacement of the brachiocephalic vein and the branch vessels
of the aortic arch anteriorly.  She presents for surgical
removal of the thyroid mass.

MEDICAL HISTORY: Subarachnoid hemorrhage s/p coiling of R PCA aneurysm
Hydrocephalus s/p VP shunt
Respiratory failure requiring trach placement
Thoracic mass: biopsied - benign thyroid nodule
Hyperthyroidism with goiter secondary to amiodarone toxicity
Anemia - prior black stools with no source found from
EGD/c-scope
Deep vein thrombosis s/p IVC filter
Hypertension
Atrial fibrillation

MEDICATION ON ADMISSION: albuterol nebs prn, atrovent nebs prn, lansoprazole 30',
levetiracetam 100mg/mL soln 15mL via PEG tube [**Hospital1 **], methimazole
15mg daily, tylenol prn, aspirin 81', ferros sulfate 300mg/5mL
liquid 5mL PEG tube [**Hospital1 **], colace 60mg/15ml syrup 60 mg [**Hospital1 **],
guaifenesin 100mg/5mL liquid 10mg PEG q6 prn

ALLERGIES: Lactose

PHYSICAL EXAM: 98.4, 76, 110/75, 15, 100% on trach mask
neck incision clean and dry with staples, bacitraicin to site
mild edema along skin flap, improving
trach in place with collar, sutures in place
PEG tube in place, no abnormal drainage or surrounding erythema
lungs clear bilaterally, coarse at times
heart is irregularly irregular, rate normal
minimal peripheral edema

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: living at home with supportive daughters prior to admission, had
been at [**Hospital3 **] for extensive stay after prolonged
hospitalization, currently not able to walk, but had previously
been able to walk with a cane or walker
no tobacco or alcohol use 

### Response:
{'Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Presence of cerebrospinal fluid drainage device,Attention to tracheostomy,Atrial fibrillation,Dysphagia, unspecified,Edema,Anemia, unspecified,Unspecified essential hypertension,Osteoporosis, unspecified,Personal history of venous thrombosis and embolism,Gastrostomy status,Cardiac rhythm regulators causing adverse effects in therapeutic use'}
