About three months ago, I went to a village nearby to scout for potential candidates to treat. A lady, very humble and friendly invited me into her house and gladly accepted my offer. I had just finished constructing her partial denture. Before doing so, I had to extract one of her teeth so the way things go in USM, it's always about holistic approach in managing our patients. This means we're not supposed to look at the face and mouth alone, but the health of the whole body is a crucial element to be examined too. While examining her neck, I noted thyroid enlargement with associated bilateral upper cervical and submandibular lymph nodes enlargement. Each of them was about 2cm in diameter, mobile, smooth-surfaced, firm, and non-tender to palpation (percussion of manubrium was resonant). Although initially she claimed not to have any significant past medical history, I managed to find out that she has a thyroid disorder and was on follow-ups at a clinic nearby. She said it's just goiter and the medical officer in-charge said it's nothing to be worried about. Neither a benign nor malignant tumour, but with discovery of cervical lymphadenopathy, I personally didn't think it's a simple case of goiter. I pointed out to the master student in-charge but he said, "Proceed. It's nothing, I guess, since she's on follow-ups already". Through out the extraction process, I couldn't take my mind off that matter. I held the patients hand. It was abnormally warm. My hands are always warmer than my colleagues, but hers were warmer. I felt her pulse. It was nearly 90/minutes and she was not anxious about anything... and so she said. Those are the signs of deranged thyroid hormonal level.
After completing the extraction, I saw the master student again, and insisted on referring her to oral maxillofacial clinic. Alhamdulillah, my request was accepted. Months passed and along the construction of her denture, I learned that fine needle aspiration was done on her lymph nodes and thyroid gland. Today, I received the very news I had dreaded for months - the result came out and it was papillary carcinoma of the thyroid - in laymen term - thyroid cancer. Nonetheless, to every cloud, there's a silver lining. It was still in early stage. The lymph node turned out to be unaffected. Still, I have another task to complete albeit completing her denture already - to persuade her to undergo surgery to remove her thyroid. The thing about dealing with villagers is... they usually trust alternative medicine more than the modern ones. Obviously she chose the former and I hate to see her condition deteriorating simply because of having lack of knowledge in this field - at least not after she gave me two bags of serunding :P May Allah open her heart to accept this treatment.
I learned an important lesson myself - Alhamdulillah, the extraction was uncomplicated but if she had thyroid storm later, I might've quit the school, but Allah teaches us in amazing ways. So dear dental students of USM, don't feel all that bad for having to learn medicine. You'll encounter cases that'll amaze you so much you'll feel so grateful for having the knowledge - at least a basic one.