Lump on neck two week urgent referral advice please

[Mst27]

Hi I mentioned to my doctor in January that I had a swelling on my neck. This was a phone appointment and he said that happens with hypothyroidism. Last week I spoke to a different GP about me struggling with panic attacks and anxiety which I thought was related to my increase in medication. She said I was clutching at straws and that I was probably depressed. I mentioned the swelling which has got bigger and she booked an in person appointment two days later. She said the lump felt squishy and she thought it was under my thyroid and referred me for an urgent ENT Appointment and an urgent ultrasound. I have an appointment with ENT on Monday. Has anyone had experience of this and could give me advice on what to expect or questions I should ask? I was diagnosed with hypothyroidism in October and my last increase was 11th April to 75 a day. I’m hoping it’s nothing serious but it has shaken me a little. Any advice or insight would be greatly appreciated.

[PurpleNails Administrator]

I’m not entirely convinced your GP can tell if the thyroid or under thyroid from feel alone. That’s why a ultrasound is required. If it’s squishy it’s could be a fluid filled cyst, but again it really hard to tell from feel alone.

I have neck lumps which bounce or wobble on feel making them appear squishy but they are solid or inflamed areas. There’s lots of lumps that can occur in neck. All benign - I’ve had scans for solid nodules, & inflamed saliva glands. Then there cysts & reactive lymph nodes.

Is your hypothyroidism autoimmune? Nodules are very common with Hashimoto’s and are quite common in healthy thyroid too. if you are hypothyroid & under medicated the entire thyroid can swell including making any thyroid nodules more swollen & symptomatic.

ENT will just be looking for a physical issue & ultimately if the lump needs surgical removal. It’s likely that they will scan and says it’s nothing to worry about. If there’s any concern (even if a very remote concern) they will arrange a fine needle biopsy or drain the cyst fluid to test it as a precaution.

They will not do blood tests and look at thyroid function they will assume GP has managed this.

What’s was you last FT4 & FT3? Are they in top third of range? What are folate, ferritin, b12 & vitamin D like.

[Mst27 in reply to PurpleNails]

Thanks for taking time to respond it helps. My results from 11/4 T4 14.2 ( 11-21)TSH 4.7 (0.27-4.2)

January results

Ferritin 28(13-150)

Folate 11(3-20)

I supplement with vit b complex and vit D 2000 daily

I do have autoimmune hypothyroidism as I tested positive for this

You have helped put my mind at rest thank

You

[PurpleNails Administrator in reply to Mst27]

Ferritin is Low - under 30 Is deficiency and requires investigation has GP done iron panel?

TSH above range & FT4 only 32% of range . TSH should alway be under 2 most don’t feel well until TSH around 1 & FT4 in top third of range.

Were you given increase of levo, with these results? This needs retesting 6-8 weeks later.

FT3 would also ideally be tested as most hypo symptoms are from low FT3 but NHS do not always test & go by TSH.

[Mst27]

Hi I had an increase with these results and will re test in a few weeks. Doctors said iron was low and to increase it through my diet which I have tried to do. I will try to get a private blood test for my FT3. Thanks again

[samaja]

Just in case it might be useful to also test for paratharoids disease shich can also present with a neck lump.