Midline Neck Lump Flashcards
What are the thyroid causes of a midline neck lump?
- Phsyiological goitre
- Multinodular goitre
- Graves disease
- Hashimotos thryoiditis
- Thyroglossal cyst
- Thyroid cyst
- Solitary adenoma
- Carcinoma
- Subacute thryoiditis
What are the non-thyroid causes of a midline neck lump?
- Lipoma
- Dermoid cyst
- Epidermal cyts
- Abscess
- Lymphoma
What questions should a GP ask about a midline neck lump?
- How long has lump been there
- Has lump changed size
- Is lump painful
- Other lumps
What would a sudden onset of a midline neck lump suggest?
- acute haemorrhage into a thyroid cyst
- fast growing thyroid carcinoma
- subacute thyroiditis
What would a gradual onset of a midline neck lump suggest?
thyroglossal cysts (can show up after infection)
What would be an increasing size midline neck lump suggest?
- haemorrhage
- infection of an existing lump
What would a slow growing midline neck lump suggest?
thyroid neoplasms (not anaplastic carcinoma)
What would a painful midline neck lump suggest?
- subacute thyroiditis
- infected thryroglossal cysts
- acute haemorrhagic cysts
What would a discomfort when swallowing midline neck lump suggest?
hashimotos
What would other lumps as well as a midline neck lump suggest?
cervical lymphadenopathy, malignant until proven otherwise
What assoicated symptoms should the GP ask about with a midline neck lump?
- Hypothyroidism, hyperthyroidism?
- Any symptoms suggestive of compression or invasion?
- Any symptoms of infection (malaise, fever, rigor)?
What would hypothyroidism symptoms be?
- Apathetic/ blunting or thought/ fatigue
- Weight gain
- Constipation
- Cold intolerance
What would hyperthyroidism symptoms be?
- Irritable/nervous/ restless
- Increased appetite and weight loss
- Diarhhoea
- Heat intolerance
- Palpitations
- Oligomenorrhoea
What can cause compression or invasion?
- if goitre so large can exert pressure on surrounding tissues and cause symptoms e.g. stridor, dyspnoea, dysphagia and or discomfort during swallowing
- Changes in voice due to malignant tumour invading recurrent laryngeal nerve or hypothyroidism can cause oedema of vocal cords
Why is asking about autoimmune disease in PMHx important with midline neck lump?
Graves and Hashimotos thyroiditis is more common if already autonimmune disease
Why is asking about known risk of thyroid malignancy in PMHx important with midline neck lump?
previous radiation to neck risk factor for subsequent development of papillary thyroid carcinoma
Why is asking about autoimmune disease in FHx important with midline neck lump?
family predisposition
Why is asking about hereditary forms of thyroid carcinoma in FHx important with midline neck lump?
25% of medullary thyroid carcinoma (MTC) familial or part of MEN-2
What questions do you ask about lump and location in a midline neck lump?
- Location
- Relationship to other structures
- Character of lump
What questions do you ask about lump and location in a midline neck lump?
- Location
- Relationship to other structures
- Character of lump
What would a superficial midline neck lump suggest?
- lipoma
- epidermal cyst
- . dermoid cyst
- abcess
What would a deep midline neck lump suggest?
thyroid gland
What would a moves on swallowing midline neck lump suggest?
thyroid gland (attached to pretrachea fascia)