How much do you know about "big neck"?

This is the 3536th article of Da Yi Xiao Hu

“A big head and thick neck are either a rich man or a cook.” Of course, a “thick neck” may also mean that you have a thyroid disease! To understand thyroid diseases from a surgical perspective, we must first distinguish between the two concepts of “diffuse thyroid enlargement” and “thyroid nodules.”

"Diffuse thyroid enlargement" refers to the uniform enlargement of both lobes of the thyroid gland, and the absence of nodules on palpation. It is caused by hypertrophy of thyroid cells, hyperplasia of blood vessels, and congestion. "Thyroid nodules" refer to lumps in the thyroid gland that can move up and down with the thyroid gland during swallowing. It is a common clinical condition that can be caused by a variety of causes.

The thyroid gland may enlarge due to various reasons, and the most common symptom is compression, such as: compression of the trachea causing dyspnea or hemoptysis; compression of the esophagus causing swallowing difficulties; compression of the recurrent laryngeal nerve causing hoarseness; compression of the sympathetic nerve causing Honer syndrome, which may cause unilateral pupil constriction, enophthalmos, ptosis, and anhidrosis on the affected side of the face. Severe compression symptoms may lead to suffocation and endanger life. Therefore, we need to understand the thyroid diseases related to neck swelling so that we can be alert when symptoms occur.

"Diffuse thyroid enlargement" is mainly seen in the following four diseases in clinical practice: simple goiter, primary hyperthyroidism, chronic lymphocytic thyroiditis, and subacute thyroiditis. Next, let me briefly introduce these four diseases to you.

Simple goiter

Iodine deficiency, the raw material for thyroid hormone synthesis, increased thyroid hormone requirements in women during puberty, pregnancy or menopause, and disorders in thyroid hormone synthesis and secretion can all cause goiter, which is more common in women.

Clinical manifestations

The thyroid gland is diffusely enlarged. When intracystic bleeding occurs, the nodules will rapidly increase in size. Simple goiters may cause compression symptoms when they are large in size.

Primary hyperthyroidism

(Hyperthyroidism, exophthalmos goiter)

Hyperthyroidism refers to an endocrine disease caused by the inappropriate and continuous synthesis and secretion of excessive thyroid hormones while the thyroid gland is enlarged. It is more common in young people aged 20 to 40.

Clinical manifestations

Diffuse enlargement of the thyroid gland, bulging eyes, irritable temperament, insomnia, trembling hands, hot flashes and sweating, increased appetite but weight loss, palpitations, endocrine disorders (such as menstrual disorders), easy fatigue, etc.

Chronic lymphocytic thyroiditis

(Hashimoto's Thyroiditis)

This disease is an autoimmune disease, mainly caused by the immune system attacking the thyroid gland, resulting in hypothyroidism, that is, the thyroid gland cannot produce enough thyroid hormone to meet the needs of the human body. It is more common in women aged 30-50.

Clinical manifestations

Most of them are painless diffuse goiters, which are symmetrical, hard, and have a smooth surface. They are often accompanied by hypothyroidism, and larger glands may have compression symptoms.

Subacute thyroiditis

( Thyroiditis or Giant Cell Thyroiditis )

This disease often follows a viral upper respiratory tract infection and is a common cause of anterior neck lumps and thyroid pain. It is more common in women aged 30 to 40.

Clinical manifestations

Most cases present with sudden swelling and pain in the front of the neck, which radiates to the ear and temporal area on the affected side. The course of the disease is about 3 months, and the patient may have a fever. After recovery, the thyroid function returns to normal.

"Thyroid nodules" are divided into single nodules and multiple nodules. In clinical practice, single nodules are mainly seen in the following two diseases: thyroid adenoma and thyroid cancer; multiple nodules are mainly seen in nodular goiter.

Thyroid adenoma

This disease is a benign tumor originating from the thyroid follicular cells. It is the most common benign thyroid tumor. It is usually a single nodule with a complete capsule and a size of 1 to 10 cm. It may become malignant. It is more common in women under 40 years old.

Clinical manifestations

Round or oval nodules appear on the neck, mostly single, slightly hard, smooth, and non-tender. When the blood vessels in the cyst wall rupture and bleed, the tumor can rapidly increase in a short period of time, causing local swelling and pain. Symptoms of hyperthyroidism may also occur.

Thyroid cancer

Thyroid cancer is the most common thyroid malignancy. The vast majority of thyroid cancers occur in one lobe of the thyroid gland and are often single tumors. The thyroid gland includes four pathological types: papillary carcinoma, follicular carcinoma, undifferentiated carcinoma, and medullary carcinoma. Papillary carcinoma is common in children and young and middle-aged people aged 30 to 45, with more cases in women than in men; follicular adenocarcinoma is common in middle-aged people around 50 years old; and undifferentiated carcinoma is common in the elderly around 70 years old.

Clinical manifestations

Typical clinical manifestations are a mass found in the thyroid gland, which is hard and fixed, with an uneven surface and little up and down movement of the gland during swallowing. In the late stage, there will be invasion and compression symptoms: dyspnea or hemoptysis, dysphagia, hoarseness, Honer syndrome, and pain in the ear, occipital, and shoulder areas. Local lymph node metastasis may cause cervical lymphadenopathy.

Nodular goiter

This disease usually develops from diffuse goiter. As the lesion continues to develop, it forms a nodular goiter, which is usually multiple nodules. The degree of goiter varies and is often asymmetric. It is more common in young and middle-aged people over 30 years old, and more common in women than in men.

Clinical manifestations

The nodules are soft or slightly hard, smooth, and non-tender. Larger nodular goiters may cause compression symptoms. Acute bleeding in the nodules may cause sudden enlargement of the tumor and pain, and the appearance of hyperthyroidism symptoms.

Through the above introduction, do you have a preliminary understanding of thyroid diseases related to neck swelling? We should not take the thickening of the neck lightly. We cannot make a very accurate diagnosis of the disease based on clinical symptoms alone. Therefore, we should neither blindly identify the corresponding symptoms nor ignore them. The most reasonable way is to seek medical treatment in time, through a specialist physical examination by a physician, combined with biochemical and imaging examinations to identify the disease, so as to achieve early detection, early diagnosis, and early treatment to avoid delayed diagnosis and treatment. Finally, I wish you all good health and stay away from diseases!

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

General Surgery Nail and Breast Specialty Group

Dr. Li Yujin

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All names and place names are pseudonyms and any similarity is purely coincidental.