History of a Neck Lump and assessment of thyroid

status
Personal History
Age - the risk of malignancy increases with age.
Ethnic Origin - Asian patients with enlarged neck nodes have a higher
incidence of metastatic nasopharyngeal cancer or tuberculosis.
Occupation - occupational exposure to asbestos, nickel and wood
dust are associated with an increased risk of head and neck cancers.
History of the lump

Site - 1 or 2+, Localised or generalised (is it an isolated lump or

is the entire neck swollen?)

Shape

Size

Consistency hard, soft, cystic, nodular?

Is it painful? SOCRATES- Suggests acute inammation or

infection

Onset:
When was the lump rst noticed?
- A rapid onset painful swelling suggests an inammatory
lymphadenopathy.
- A slowly progressive, non-painful lump suggests malignancy.

Duration:
- Inammatory lumps settle once the primary infection is
treated.
- A neck lump which is persistent (> 6 weeks) with or without
associated symptoms needs referral to an ENT surgeon.

Any growth or changes to the lump? And the timescale of this.

Fluctuance? Does the lump come and go?

Surroundings any skin rashes or disclouration?

Fixation - to underlying structures is more suggestive of

carcinoma.

Does the lump move with:

- Swallowing (thyroid mass/thyroglossal cyst)
- Tongue protrusion? (thyroglossal cyst)

Any previous lumps?

Associated Symptoms:
Consider other features in the history that may suggest a cause:
! Symptoms of hyperthyroidism
- Weight loss
- Increased or decreased appetite
- Irritability
- Weakness and fatigue
- Diarrhoea Steatorrhoea
- Sweating
- Tremor
- Mental illness: may range from anxiety to psychosis
- Heat intolerance
- Loss of libido
- Oligomenorrhoea or amenorrhoea
! Symptoms of hypothyroidism
- Tiredness, lethargy, intolerance to cold
- Dry skin and hair loss
- Slowing of intellectual activity, e.g. poor memory and di!culty
concentrating
- Constipation
- Decreased appetite with weight gain
- Deep hoarse voice
- Menorrhagia and later oligo- or amenorrhoea
- Impaired hearing due to uid in middle ear
- Reduced libido
! Symptoms of hypercalcaemia (suggestive of
Hyperparathyroidism)
Stones (renal calculi), moans (psychological symptoms
depression, mild cognitive impairment and confusion), groans
(constipation), bones (boney pain).
Other symptoms can include: anorexia and nausea, vomiting,
lethargy, muscle weakness, pancreatitis, polyuria, polydipsia,
dyspepsia, abdominal pain and arrythmias.
! Symptoms suggestive of an infectious or inammatory
cause:

Recent history of illness

Infections of the ear, nose, throat, scalp and teeth commonly
cause lymphadenopathy in the neck. Enquire about symptoms
of:
fever and rigors, sore throat, cough, ear ache, rash, tooth
infections.

Recent travel, insect bites, exposure to pets or other animals

or contact history of infectious disease
! History suggestive of a traumatic cause may indicate
haematoma or in time have caused brosis.
! Symptoms suggestive of malignancy:

Local malignancy:
- Anorexia and weight loss
- Dysphonia
- Dysphagia
- Odynophagia
- Dyspnoea
- Persistent hoarseness
- Otalgia
Especially unilateral symptoms.

Haematological malignancy:
- Fatigue
- Night sweats
- Fever
- Weight loss
- Pruritus
- Breathlessness
- Bruising or bleeding
- Recurrent infections
- Bone pain, alcohol-induced pain, or abdominal pain
- lymphadenopathy at sites other than the neck
Systems Review
Past Medical History
Ask about previous cancers of the skin, lip, oral cavity and other
mucosal sites.
Drug History and Allergies
Family History

Family history of an endocrine tumour may be suggestive of

multiple endocrine neoplasia (MEN) syndrome.
Social History:
Factors that increase the risk of malignancy:

Smoking

Heavy alcohol consumption

Previous radiation to the neck