Neck Masses: Thyroid Nodules and Other Concerns

Lump in the anterior neck region?

Hello Doctor: I would like to ask: 1.
During a neck ultrasound, if the patient's neck is not extended due to the position of the pillow when lying down, could this lead to missing potential nodules in the thyroid during the examination? 2.
In the anterior neck area, specifically around the thyroid region, if something is palpated, aside from nodules on the thyroid, what else could it be? I have felt two round masses (they require some pressure to palpate and do not feel like they are on the surface of the skin).
They feel similar to nodules (I am currently monitoring benign nodules).
These round masses move when pushed, but the ultrasound examination indicated that there were no additional findings in the thyroid aside from the nodules being monitored, which has left me confused.
The doctor did not provide further explanation at the time, only stating that lymph nodes could not be palpated in that area.
However, I can still feel those two masses at home.
Could you please clarify this for me? Thank you.

Danxin de ren, 30~39 year old female. Ask Date: 2020/08/12

Dr. Zheng Jueyi reply Otolaryngology

Hello, slight differences in posture generally do not affect the examination results.
It is currently unclear what was felt during the examination, but if the physician did not detect any other abnormalities during the ultrasound, it would be advisable to observe and schedule regular follow-up visits.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/08/12

More Info

When it comes to understanding neck masses, particularly thyroid nodules and other potential concerns, there are several important aspects to consider. Your questions touch on the nuances of ultrasound examinations and the differential diagnosis of palpable masses in the neck region.

1. Impact of Patient Positioning on Ultrasound Results:
It is indeed possible that the positioning of the patient during an ultrasound can affect the visibility of certain structures, including thyroid nodules. If the neck is not extended properly, it may obscure some areas of the thyroid gland, potentially leading to missed nodules. However, experienced sonographers are trained to adjust the transducer and the angle of imaging to optimize visualization of the thyroid, even if the neck is not fully extended. If there are concerns about the thoroughness of the examination, it may be worth discussing with your healthcare provider the possibility of a repeat ultrasound, ensuring proper positioning to maximize the chances of detecting any abnormalities.

2. Differential Diagnosis of Palpable Masses in the Anterior Neck:
The anterior neck is home to several structures, and while thyroid nodules are a common concern, other potential causes for palpable masses should also be considered. These can include:
- Lymph Nodes: Enlarged lymph nodes can be felt in the neck and may indicate infection or other pathological processes.

- Thyroglossal Duct Cysts: These are congenital anomalies that can present as midline neck masses, often movable and may become infected.

- Branchial Cleft Cysts: These are also congenital and can appear as lateral neck masses.

- Salivary Gland Issues: Conditions affecting the salivary glands, such as sialadenitis or tumors, can also present as palpable masses.

- Other Thyroid Conditions: Besides nodules, conditions like goiter (enlargement of the thyroid) can also be felt as a mass.

The fact that you can palpate these masses and that they are described as movable suggests they may not be directly associated with the thyroid gland itself, especially if the ultrasound did not reveal any concerning findings. However, it is essential to follow up with your healthcare provider regarding these findings. They may recommend further imaging, such as a CT scan or MRI, or even a fine needle aspiration biopsy if there is any suspicion of malignancy or if the masses change in size or characteristics.

In summary, while ultrasound is a valuable tool for evaluating thyroid nodules, the positioning of the patient can influence the results. Additionally, various other conditions can present as palpable masses in the neck, and it is crucial to have a thorough evaluation to determine the nature of these findings. If you have ongoing concerns or if the masses change, it is advisable to seek further evaluation from an ear, nose, and throat (ENT) specialist or an endocrinologist who can provide a more detailed assessment and management plan.

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