Case 4 – Neck Mass

You are seeing Mrs. Nguyen, a 52 year old woman, because she noticed a large swelling on her neck. Take a focused history and perform a focused head and neck examination.


  • Clarifies location of mass (patient thinks it’s on the her right side of her neck)
  • Onset of mass
  • Progression in size
  • Pain
  • Dysphagia
  • Odynophagia
  • Change in voice
  • Symptoms suggestive of hyperthyroidism
  • Symptoms suggestive of hypothyroidism
  • Systemic symptoms – weight loss, night sweats, anorexia
  • Infectious symptoms – nausea/vomiting, fever, diarrhea
  • Past medical history
  • Personal history of malignancy
  • Exposure to head and neck irradiation
  • Exposure to tobacco, smoking, alcohol, and betel nuts
  • Asks patient about ethnic origin (South East Asia)
  • Personal history of thyroid disease
  • Family history of thyroid disease
  • Family history of head and neck cancer

Physical Examination


  • Comments on location of mass and any neck asymmetry
  • Comments on stigmata of hyperthyroidism in head and neck (exophthalmos, lid lag, etc.)
  • Comments on stigmata of hypothyroidism in head and neck (skin and hair changes)
  • Comments on size of thyroid and observes thyroid as patient swallows


  • Comments on quality, size, and mobility of mass (mass is hard, irregular, and tethered)
  • Comments on size of mass (~2 cm in diameter)
  • Palpates all lymph node regions of the head and neck
  • Names the regions which are being palpated
  • Comments on the size, texture, mobility, and location of nodes that are identified
  • Asks patient if palpation is tender
  • Palpates both lobes of the thyroid; comments on size and nodularity
  • Auscultates thyroid and comments on absence of bruits
Case 4 – Neck Mass