Having Pinching In Neck And Shoulder. Thyroid Report Shows Initial Adenoma. Should I Worry?

Posted on Tue, 26 Nov 2013

Question: My Sinus and ear fluid problem has gone, along with headaches too. But I am still having frequent aches around neck from time to time, at times feels like pinching. Looking at my history my doctor order two tests Thyroid ultrasound and ESOPHAGRAM. Results from Esophagram: Barium and granules were administered orally without difficulty. Esophagus is normal in mucosal pattern and motility. No hiatal hernia is evident, no gastroesophageal reflux was visualized during the study which doesn't exclude that diagnosis. The opacified portions of the stomach and proximal small bowel are considered with in normal limits. Rapid sequence imaging of the cervical esophagus appears normal as well. Results from Thyroid ultrasound: The thyroid gland is homogeneous throughout. The right thyroid lobe measures 4.8*1.7*1.1 cm. The left thyroid lobe measures 5.1*1.7*1. cm. The isthmus measures 3.5 mm. Normal echogenicity and blood flow. Posterior to the mid aspect of the left thyroid lobe there is a 7*5*6 mm isoechoic nodule. This could represent a parathyroid nodule The calcium test shows ionized calcium of 5.5 mg/dl and calcium serum 10 mg/dl (which my doctor think is normal) I have also visited GI and they found everything normal. I still have lot of pinching in neck and shoulder. Also I am not clear what is that initial adenoma (7mm) in my thyroid report.. Is that something I should worry about..?

Answered by Dr. Shehzad Topiwala (1 hour later)

Brief Answer: Thyroid nodule is likely benign Detailed Answer: The vast majority of thyroid nodules are not cancerous. So most endocrinologists do not get concerned about a thyroid nodule of the size you are reporting. However there are exceptions ie if you have any major risk factors that place you at an elevated risk for thyroid cancer then it may be worthwhile performing a biopsy (FNA = Fine Needle Aspiration ). Some of the risk factors include : a family history of thyroid cancer and exposure to radiation in the head/ neck area. This radiation is not referring to just CT scans or routine X rays but more to treatment type radiation given for head/neck region cancers. In such instances, nodules smaller than 1 cm are also often biopsied. Your nodule is 0.7 cm in its maximum dimension. Usually nodules this size do not cause pressure symptoms in the neck like pain or hoarseness etc. I have noted the other results. Looks like the GI side of things is ok. Have you consulted an ENY surgeon?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (30 minutes later)

I don't have family history of thyroid nor I had any exposure to radiation except ct scan.. I have got an appointment with a surgeon after 2 months. My current symptoms are pinching and pain around neck and shoulder area. Also I always feel like I can't pop open my ears (that is after the ear sinus infection I had 2 months back). Although there is no fluid pressure, but I do feel like air pressure. My ENT says my ears and sinuses are normal without any fluid..

Answered by Dr. Shehzad Topiwala (7 hours later)

Brief Answer: Difficult to pinpoint cause Detailed Answer: I see. Neck symptoms typically fall in the ENT and Gastroenterology domain, once the thyroid is ruled out. You seem to have had thorough evaluations of all 3 potential aspects without arriving at a specific cause. It can be frustrating in such situations. I would leave further evaluation to the discretion of your primary doctor to see if rheumatology/ orthopedic consultations are due. The radiologist can sometimes report characteristics of the thyroid nodule which help one decide whether or not biopsy is indicated. the report you provided earlier.....was that an ultrasound of the neck/ thyroid or a CT Scan ? If it was a CT, then it is definitely required to get a thyroid focused neck ultrasound because ultrasound is a better way to study the thyroid most of the time

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (11 hours later)

I visited orthopedic and the neck structure was fine from their side without calcification. For neck / thyroid I had the ultrasound not CT Scan.

Answered by Dr. Shehzad Topiwala (36 hours later)

Brief Answer: Ionized calcium Detailed Answer: What is the normal range on the laboratory report that you have for ionized calcium?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (3 days later)

I am not sure about that.. But my doctor said it is in normal range. Most of my problems seems to be cleared. Except the neckline pain (feels like bulging) and around shoulder. Apart from that I have frequent fluid in the ears, which seems to go up and down daily. Reference Interval: 4.5-5.6 mg/dL for ionized calcium from the lab..

Answered by Dr. Shehzad Topiwala (9 hours later)

Brief Answer: Diagnostic challenge Detailed Answer: If the ENT, orthopedic and gastroenterologist have not been able to figure this out, this is certainly a challenging problem. I hope you find a doctor who can help you determine the cause of these perplexing symptoms

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar