What do I do if I have swelling in the neck: Mumps, Lymph nodes, Goiter, Thyroid enlargement.

A person with neck swelling has enlargement of the soft tissues that covers the neck. A neck swelling can also occur as accumulation of fluid, lymph, or inflammatory, or tumor cells in an area under the skin of the neck. Clinically speaking swellings in the region of neck are of great importance as they not only help in diagnosing some serious underlying disease but are also easy to treat if they are benign. Most of the times a simple surgical procedure is all we need.

Neck swelling may be caused by an injury, inflammation, infection, or a benign / malignant tumor. In mild cases of neck swelling, treatment may not be required. If the neck swelling is bothersome, over-the-counter medications such as anti-inflammatory drugs or pain medications or cold compresses may help reduce discomfort and swelling. In more serious cases, a visit to a medical professional may be necessary to determine the cause of neck swelling and appropriate treatment. Seek medical attention if your symptoms of neck swelling, or those of someone you are with, are accompanied by sudden swelling of the face, lips, or tongue, or breathing problems such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking. These symptoms may be signs of a severe allergic reaction.

Anatomy of the neck

Benign skin conditions can cause small areas of the neck to appear swollen. Swelling of the lymph nodes in the neck is a common symptom of many different types of viral and bacterial infections as well as many benign and malignant disorders. Lymph nodes are small organs distributed in the body which collect fluid. They get swollen if inflammatory fluid deposits in them. They are also swollen if cancer cells from an organ reach them in case they are said to have metastasized. In the neck they are present in distinct groups and are almost always show as medium to small size swelling mostly on the sides of the neck and / or under the jaw. Have a look at this illustration, it shows different groups of nodes in and around the neck.

you can see different sets of these lymph nodes like sub-mandibular, and occipital. So their enlargement is either benign or malignant. These nodes are also swollen in cases of TUBERCULOSIS (TB). TB is a treatable disease which affects millions of people all over the world. A biopsy result of the neck swelling, from a pathology laboratory is all you need.

If the swelling is on one or both sides of

Lymph nodes in the neck

the neck just below the ear lobe, it may be MUMPS. In that case immediately consult your doctor. Mumps is a viral infection and can have serious side effects long after the swellings have disappeared. This viral attack  can lead to swelling and pain in the salivary glands (Parotid glands), along with fever, loss of appetite, and fatigue. It mostly occurs in children but can affect us in later life. Remember there is a vaccine against Mumps which protects us from this viral infection.

MUMPS: A viral illness which causes swelling of Parotid glands.

There are some skin causes of neck swelling:

Neck swelling may be caused by a variety of skin conditions including:

  • Acne
  •  Boils
  • Cyst (a benign collection of fluid)
  • Lipoma (collection of fatty tissue under the skin; a benign condition)
  • Skin infections

Other causes of neck swelling

Neck swelling can also be caused by a variety of other conditions including:

  • General infection leading to swollen lymph nodes in the neck region
  • Goiter (an enlarged thyroid gland)
  • Mumps (viral infection of the salivary glands in the neck)
  • Recent neck injury or trauma
  • Recent neck surgery

Other causes of lymph node swelling in the neck are the blood cancers like Leukemia, Lymphoma and Hodgkin disease.

In some cases, neck swelling may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Anaphylaxis (severe allergic reaction)
  • Angioedema (a severe swelling beneath the skin that can cause breathing difficulty)
  • Cancer of the throat, thyroid gland or other structures in the neck

LUMP IN THE NECK WHICH IS DUE TO THYROID ENLARGEMENT (GOITER):

A goiter is an enlarged thyroid gland. Some people with a goiter (but not all) have an under-active or overactive thyroid.  A goiter can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid.
The thyroid gland is in the lower part of the front of the neck. It lies just in front of the trachea (windpipe). It has a right and left lobe which are connected together by a narrower band of thyroid tissue. (It is roughly the shape of a butterfly.) You cannot usually see or feel a normal thyroid gland. If the thyroid enlarges it causes a swelling in the neck which you can see – a goiter. There are various causes of goiter and treatment depends on the cause. As such the thyroid swellings can also be classified as benign or malignant. The benign swellings do not cause spread of the disease and are mostly fluid collection in some part of the gland. Hemorrhage in the gland is another example where a neck swelling is observed. Thyroid swellings are prominent and are always situated in front of the neck (see illustration). They may be mobile (moving with swallowing) or fixed. If the swelling is benign   and is mobile, there are chances that it is not dangerous at all and a simple surgical procedure will correct it.

In case of more than one swelling (lumps) in front of the neck which are due to thyroid enlargement, they are called as Multinodular goiter while a single swelling (lump) is termed as simple nodular goiter.

CAUSES OF SIMPLE OR NODULAR GOITER:

Always remember that a thyroid swelling does not mean there is an element of dysfunction also (please see previous blogs about hypothyroidism and hyperthyroidism).

Simple diffuse goiter

They may be there due to IODINE DEFICIENCY in which case they are termed as IODINE DEFICIENCY GOITER. In most of the cases they are diffuse (no nodularity is seen). When there is no nodule palpable in the neck and there is diffuse swelling, it is SIMPLE GOITER. It can also occur at puberty in young girls and is called PUBERTY GOITER.

Diffuse/Simple goiter:

This means that the entire thyroid gland is larger than normal. The thyroid feels smooth but large. There are a number of causes. For example:

  • Grave’s disease – an auto-immune disease which causes the thyroid to swell and make too much thyroxine.
  • Thyroiditis (inflammation of the thyroid)
  • Iodine deficiency. The thyroid gland needs iodine to make thyroxine(T4) and T3. If you lack iodine in your diet the thyroid swells as it tries to make enough of its hormones which are so vital for our bodily functions like metabolism and control our heart rate and many other functions
  • Some medicines can cause the thyroid to swell as a side-effect. For example, lithium and treatment of Hepatitis C
  • Hereditary factors – some people inherit a tendency for a thyroid to swell. In particular, it may swell at times of life when you may make more thyroxine and T3. For example, when you are pregnant, or during puberty.

Nodular goiter

A thyroid nodule is a small lump which develops in the thyroid gland, in front of the neck. There are two types:

  • A multinodular goiter. This means the thyroid gland has developed many lumps or ‘nodules’. The thyroid gland feels generally lumpy.
  • A single nodule. Causes include:
    • a cyst (swelling with fluid in it)
    • an adenoma (a solid lesion in the gland composed of glandular cells)

      large multinodular goiter
    • a benign or malignant tumor
IF I HAVE GOITER DOES IT MEAN MY THYROID GLAND IS MALFUNCTIONING?
  • In many people with a goiter it does not affect the amount of thyroxine T4 or T3 that they make. You are then Euthyroid which means you make the correct amount of these hormones.
  • In some people, the goiter is associated with an abnormality of thyroid function. You may make too much thyroxine or T3 (hyperthyroidism) or too little thyroxine or T3 (hypothyroidism) For details please see related posts in this blog.

WHAT STEPS ARE TAKEN TO ASSESS / DIAGNOSE A GOITER:

1. Blood samples are taken to evaluate the amount of circulating thyroid hormones in the body. Normal T4, T3, and TSH means you are Euthyroid while over active and under active thyroid gland is also established and then the treatment starts according to the condition.

2. An ultrasound scan of the thyroid is done. This may be done if you have a single nodule. An ultrasound scan is a safe and painless procedure which uses sound waves to create images of organs and structures inside your body. It can tell if a nodule is a cyst or a solid lump.

3. A radioactive iodine scan. This scan is done (details given in the next post) to establish the uniformity or nodularity of the gland and whether some part of it is HOT or COLD. The hot spots on a radionuclide scan mean this portion of the gland is making more hormones (T4 and T3) than the surrounding gland and a COLD nodule means this area of the gland is not properly functioning. If on scan results there is a COLD NODULE, it is usually suggestive of malignancy (Thyroid cancer) and appropriate medical opinion must be sought immediately.

4. Biopsy: A small piece of tissue (a biopsy) may be taken from a nodule to look at it under the microscope. The biopsy is done by inserting a fine needle into the nodule. (It is like taking a blood sample but the needle is smaller.) It is a simple and safe procedure.

TREATMENT OF GOITER:

  • If you have a small goiter, and your thyroid is making the correct amount of thyroxine and T3, then you may not need any treatment. It happens in patients who has simple diffuse goiter
  • You will need treatment if you make too much or too little thyroxine T4 or T3
  • An operation to remove some or all of the thyroid may be an option in some cases
  • Radioactive iodine treatment may be an option for a goitre causing an overactive thyroid. This involves taking a drink, or swallowing a capsule, which contains radioactive iodine (I-131). The radioactive iodine builds up in the thyroid gland. As the radioactivity is concentrated in the thyroid gland, it destroys some thyroid tissue mainly by it beta emissions. If too much of thyroid is destroyed, there is replacement therapy in the form of thyroxine tablets. Their use and the fact that radioactive Iodine treatment is not particularly harmful (it is not given in pregnant or lactating mothers or prospective mothers), this form of treatment for Grave’s disease (toxic goiter) is very useful.
  • If you have cancer of the thyroid, you will probably need an operation to remove the cancer and some of the thyroid gland. The strategy to deal with this cancer will be outlined by an Oncologist with the aid of a surgeon.
  • Iodine replacement, if the goiter is due to lack of iodine in the diet.

NOTE: If you have any questions, you can always ask the author who is a thyroid diseases consultant.

Published by Dr. Afaq Ahmad Qureshi

Physician, writer, broadcaster, journalist, translator, free lance writer, poet, political and social analyst and critic. Writes plays and features for electronic media, interested in numerous things from sociology to medicine to history and art. interest in books and internet, writes for http://www.blogcritic.com also; editor for an internet journal; at http://twitter.com/dr_afaqaq.

171 thoughts on “What do I do if I have swelling in the neck: Mumps, Lymph nodes, Goiter, Thyroid enlargement.

  1. Great article thank you, I have multinodular thyroid but nothing done so far, my doc won’t test antibodies or further tests and says no need to get a biopsy, I’ve started taking kelp, selenium, b complex and use iodine topically on my skin and feel an improvement in the last few weeks, still have symptoms of hypothyroid like weight gain, extreme tiredness and cold hands and feet and light headed but I feel a bit better taking the supplements. Also just bought L tyrosine so going to see will thar help too.
    Doctors say bloods are in range and they may well bein rangebut not in the optimal range

    Liked by 1 person

  2. My symptoms started with a slight pain on both sides of my neck that I later realized was my thyroid. I felt around and found a hard fixed lump at the top of the throat. Over the next month the lump grew three times the size it was when I found it. I started to feel lymph nodes on the left side of my neck and some swelling of my thyroid. Not even a month later my thyroid extends to my ears and is growing into my chest cavity ‘very uncomfortable by the way’ I had a complete blood work up including t4 t3, free t4 t3, TSH and more that I can’t remember. No sign of autoimmune disease, no viral or bacterial infections, and not hyper or hypo. Now all the lymph nodes on the left side are swollen and cause no pain. The thyroid is swollen on both sides and smooth. Palpating the thyroid causes no pan however recently I have been getting shooting pains up to my left ear and down in my right shoulder and I have what I can only describe as a constant uncomfortable pressure behind my sternum. I had a ct scan befor it was this large but the report said no mass found and thyroid normal… How?! I know thyroid cancer is rare but after what was ruled out what else could it be. Don’t know if it’s related but have been having sharp pains on my left side just under the rib cage.

    Like

  3. I am 70 years old and have a puffiness around the base of my neck. Also I have been very thin all my life and the last couple of years or so I have started to gain weight. I am at least 35 lbs. overweight. I have no energy and tired all the time. I know that I have a mass in my thyroid as years ago I was told this. Biopsy was ok. This puffiness in my neck showed up a couple months ago, It looks awful and I am embarrassed because of it. Kind of bothers me as I can feel it. What do you think I should do.

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  4. I have graves disease, and been treating it by taking a pill everyday. I am 46, and durning the past 5months I have been having pain in my head behind my left ear along with dizzyness and black out spells.. it has become worse and I am in so much Pain. In this last month I have a large egg shaped lump in my head behind my left ear, and I have stabbing pain in my head and it hurts down into my neck to were I can not turn it to the left but goes to the.right with pain shooting in the back of my head and neck. I have shortness of breath, panic attacks, swilling in my neck eyes and face. I have gained weight, and my body hurts everywhere at times. I am always tired, and my hands and fingers go numb, and.feels like pins are poking me. I have passed out, blacked out, feels like I’m numb in the head. Chest pains at times and never feel good at all. Can someone help me.

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  5. Hi dr.
    I have a swelling at the base of my throat and have a persistent cough.
    I’ve been coughing for eleven weeks to date of this mail. I’ve have done sputum and xray to check for TB but all clear. I’ve done thyroid test also all clear. No amount of medicines and tablets or even antibiotics have helped. I’ve now been given something to boost my immune system. I’m worried and don’t want to go back to my gp. Which kind of dr do I see next. PLEASE HELP.

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  6. Hello Dr. Qureshi,
    I went to see my rheumatologist a few weeks ago and mentioned that I was having some pain/discomfort on the right side of my neck up to my ear and that my right armpit was painful as well. After an examination she said I had a swollen thyroid on the right side and that I have a visible lump in my right armpit. She was going to send me for an ultrasound and mammogram but I have not heard about the appointment yet.
    I am starting to get a little worried as I am having difficulty swallowing, choking on liquids as well as food. I also have noticed that I cannot get my voice out when signing and I sound raspy. Should I be taking a “wait and see” approach to this and hope that my doctors office books the appointment soon or should I be pressing the issue?
    Thank you for your time

    Like

  7. Good day Doctor,thank you so $uch for throwing more light on this topic. I was diagnosed with Euthyroid stage and my doctor said I don’t need to take any medication. He only told me to reduce my salt intake. But I feel embarrassed by the swelling on my neck each time I drink water,swallow food or talk angrily. What can I do to heal this and be as I was before.

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  8. Hi doctor,one day I found swelling in the right bottom of my neck,i went to the general physician ,he tested for thyroid but it was found normal ,also ultrasound was done ,in the report it is found that there is swelling in the left node only.The doctor did not advise me to take any medicine but asked to observe it .It is painless swelling only in the right side of the neck,I can catch it with my fingers,What should i do now? Is it a serious problem?Please guide me..

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  9. About a year ago i was told my t levels were abnormal and I more than likely have hypothyroidism. Since then I have had puss pockets in my throat. They checked for strep, it came back negative However, They gave me antibiotics. It took away the pockets and helped the swelling. The day after I completed the antibiotics I got sick. The swelling on my neck has not gone down. It is on both sides under my chin. I still have an odd cough that I call a bark and I wheeze. I have had a lump under my arm pit as well which has since gone away. The swelling has been in my neck for at least 4 months. I do not have a doctor, I am low income and cannot afford the deductibles. Please let me know if this is something to worry about or something that is just as it is due to my thyroid issue. I appreciate your time and advice. Thank you.

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  10. Dear Doctor,
    I have swelling that’s been going on in my neck. Inside that I can feel as it starts to swell. I’m 39 years old and this is over a year now. It has gotten much worse and more often the last month. It seems to swell worse when I’m looking down. Especially for any length of time. My blood work has shown normal for thyroid hyper or hypo. It’s scary and my pcp is running tests. I had a chest X-ray yesterday abd awaiting the results. I have a barium swallow in nine days. Yesterday the doctor told me it sounds like a goiter. I also swell under my chin and gave pain that’s minimal but only random times. Never a lasting pain. Btw I do smoke a pack daily since I was 16. So now twenty three years. I also have seeking thought my body. Extremities at times. Just mostly swelling that’s inside that feels horrible and like it’s going to choke me. I need help. I’m truly scared. What do you suggest? Thanks so much and God bless.

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  11. Hi Dr since I was small I’ve had a swollen neck my mom says when I was around 4 yrs old I had a big lump full of puss n was in the hospital for days they told her it might come back it might not. I just find my neck very up normal I recently went to the Dr to get checked for thyroid and I’m confused by the results
    tsh 1.390
    Thyroxine (t4) 8.5
    To uptake 33
    Free thyroxine index 2.8
    Can u please help me I really want to know if anything is wrong with my neck.

    Like

  12. Hi! I have a lump behind my left ear that starts at the base of my skull and goes down. It has been there for a couple of years and now has gotten larger. I had an ultrasound last Friday and it was white and long. I saw the tech measuring it. The ultrasound report came back as a solid nodule .4cm by .6 cm by .4 cm. It said could be a lymph node or something else (cannot remeber terminolgy, epithy maybe) and required further evaluation. I had an MRI on this today and won’t know the results until Monday or Tuesday but has me worried. Are swollen lymph nodes usually white and solid on an ultrasound?

    Like

  13. Hello Dr.

    I have a question….

    I am 30yrs old and have had problems in the past where my neck would swell but only for a couple of hours. On Friday the 17th my neck became very swollen. I went to the doctor on Monday and she said my thyroid is swollen and did a blood test. The test came back fine but the swelling has gotten worse and now a new lump has appeared on the right side of my neck above the other lump. It doesn’t really hurt it’s just sore. I am having difficulty breathing and swallowing, also I have a hard time turning my head. I told my doctor about this and all she did was prescribe me pain pills and told me to do neck exercises… Thank you for any insight on this. Also my mother has thyroid issues but has never experienced swelling. My grandfather on my mothers side has had thyroid, throat, lung, pancreas, and skin cancer. I know nothing of my fathers side.

    At this point I do not know what to do. I am always tired!! I also break out in hives and get really red on my chest sometimes. I don’t know if this has anything to do with whats going on but figured I would throw it in.

    I do not know what to do and my doctor seems not to know either.

    Like

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My Notes: Dr. Afaq Ahmad Qureshi

Its about Pakistan, the world, the people and the books

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A Mirror on Law, Religion and Polity

TheKop Curva CrossOver

All Things Milan and Liverpool

Learn 4 Free 2

Writing - Blogging - Marketing - Management

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