Help ! there's a swelling in my neck

I would put my neck out (forgive the pun) and say that lumps in the neck are either lymph glands/nodes or from the thyroid gland.

Lymph gland swellings are usually at the side of the neck, both right or left. Lymph glands are drainage portals that sieve out infections. For example, if you have a sorethroat or an ear infection, this can lead to a tender or painful lymph gland swelling. However, lymph gland swellings can also happen in more serious conditions - for example lymphoma (lymph gland cancer) or cancers in the head and neck like nasopharyngeal (nose) cancer.

On the other hand, if you have a swellling in front of your neck that bobs up and down when you swallow, you can bet your last dollar that that is coming from the thyroid gland.

The thyroid gland is a butterfly shaped gland that lies in front of the neck, below the Adam's apple, that produces hormones (thyroxine) to control body metabolism. An enlarged thyroid gland is called a goitre.

Sometimes only part of the thyroid gland is enlarged or there may be a lump arising from the thyroid gland. This is medically called a 'thyroid nodule'. Thyroid nodules are commoner in women than in men. In the usual age group of 20 - 50 years, most thyroid nodules (80%) are benign (non-cancerous). In the extremes of ages - children or the elderly, there is a high chance of the nodule being cancerous and therefore should be removed.

If you think you have a thyroid nodule, see a specialist. He will do the following ...

1. send you for an ultrasound. This is a non-radiation examination, that does not require any injection. The ultrasound will confirm that the nodule is coming out of the thyroid gland and give other information like how many nodules there are, their sizes, whether the nodules are solid or contains fluid (cystic), whether there are calcium deposits (which can be a bad sign).

2. do a blood test to check the thyroid hormones. This will additionally tell if medicine is needed to normalise thyroid function (see previous post)

3. do a thyroid uptake scan. This would involve injection of a low radioactive substance that concentrates in the thyroid gland. This helps give further information about the nodule - ie, whether it is 'hot' - lower chance of cancer, brisk uptake of the radioactive substance or 'cold' - low uptake of the radioactive substance and a 20% chance of cancer.

4. do a fine needle biopsy of the nodule. This isn't as bad as it sounds. A very fine needle, smaller than the one taken to draw a blood sample, is used, under local anesthesia, to make several pokes into the thyroid nodule. The cell material extracted is smeared on slides and sent to the histo-pathologist to read and conclude if cancer is present. No cuts, no stitching, an office procedure that should take no longer than half-an-hour.

Only with the above, can an appropriate decision be made about whether the nodule needs to be surgically removed


Keywords: lymph gland, thyroid gland