THYROID
NODULES-CLINICAL PRESENTATION (SIGNS AND SYMPTOMS) AND DIAGNOSIS
Currently, most
thyroid nodules are asymptomatic and are incidentally discovered during imaging
for another reason (e.g., carotid artery ultrasonography for stroke workup, chest
computed tomography for pulmonary disease, trauma scans etc.).
Some
patients may feel:
-a neck mass
-neck fullness (sensation of ‘excess tissue at
the base of the throat’ or ‘tightness’)
-globus sensation (sensation of a lump or ‘foreign
body’ in the throat, that does not go away with swallowing
-choking, related to fullness, squeezing
sensation in the throat
Incidental
diagnosis of a neck (thyroid) mass during routine physical examination (palpation,
often for another reason)
Pressure
symptoms-these are typically present in patients with large nodules (> 2 – 3
cm) or peripherally located where they can compress other adjacent anatomical
structures
From the trachea (most commonly)-dyspnea
(shortness of breath, most often while supine)
From the esophagus
Dysphagia – difficulty swallowing or sensation
of food getting ‘caught’ in throat, most commonly with large left-sided nodules
Odynophagia-painful swallowing
Voice changes-true voice changes typically
indicate malignant invasion of the recurrent laryngeal nerve(s). More rarely,
patients with large compressive nodules may complain of subtle voice fatigue or
weakness
Symptoms
related to abnormal thyroid function
Although
most thyroid nodules do not interfere with thyroid function, it is important to
inquire about any hyperthyroid or hypothyroid symptoms. A small number of
thyroid nodules are made up of autonomously functioning follicular cells and overproduce
thyroid hormones. Additionally, thyroid nodules can exist in a background of hyperthyroidism
(i.e. nodular Graves’ disease) or hypothyroidism (i.e. Hashimoto thyroiditis).
Diagnosis is
confirmed by neck ultrasonography.
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