Approach to Neck Mass and Goitre

Question 1

Approach to Neck Mass

Answer 1

1. Examination of neck mass
2. Determining thyroid state
3. Assessing complications of disease and treatment

Question 2

Examination of neck mass
(Inspection, Active movement, Palpation, Percussion, Auscultation)

Answer 2

A. Inspection - location, size and shape
- Initially slightly flexed to relax strap muscles
- then slightly extended to stretch overlying tissues
- Horizontal: left to right sternocleidomastoid muscle
- Vertical: suprasternal notch to thyroid cartilage
(normal: from side contour from cricoid cartilage to suprasternal notch is smooth)

B. Movement
3. Swallowing - moves with swallowing
(thyroid enclosed in pretracheal fascia with posteromedial ligament of Berry)
4. Tongue protrusion - thyroglossal cyst

C. Palpation from behind with neck slight flexed
- Start from isthmus below cricoid cartilage progressing left and right

5. Site, size, shape, surface, border, consistency
   - Unilateral or bilateral
   - Smooth, irregular, nodular
   - soft, firm, hard
6. Tenderness - thyroiditis
7. Mobility - Fixed or mobile
8. Tracheal deviation - in unilateral enlargement
9. Lymphadenopathy
10. Carotid artery

D. Percussion of sternum - retrosternal goitre

E. Auscultation over upper pole - thrills and bruit
(superior thyroid artery branches from ECA)

Question 3

Determining thyroid state