Neck masses and thyroid disease

Rationale

While the majority of neck masses are benign, it is essential to differentiate them from those that are malignant.

Causal Conditions

(list not exhaustive)

1. Benign
   1. Congenital (e.g., thyroglossal duct cyst)
   2. Inflammatory (e.g., reactive lymph nodes)
   3. Neoplasms (e.g., lipomas)
2. Malignant
   1. Thyroid nodules
   2. Nonthyroid head and neck cancers
   3. Lymphomas

Key Objectives

Given a patient with a neck mass, the candidate will diagnose the cause, severity, and complications, and initiate an appropriate management plan. Particular attention should be paid to excluding malignancy.

Enabling Objectives

Given a patient with a neck mass, the candidate will

1. list and interpret critical clinical findings, including those derived from
   1. an appropriate history and physical examination, paying particular attention to
      1. risk factors predisposing to malignancy (e.g., smoking, alcohol use disorder),
      2. time course,
      3. presence of pain and swallowing or systemic symptoms, and
      4. signs or symptoms of thyroid dysfunction;
2. list critical investigations and interpret the results of the investigations (recognizing when investigations are not required), including
   1. thyroid function testing, and
   2. diagnostic imaging;
3. construct an effective initial management plan, including
   1. reassurance and appropriate follow-up for suspected benign lesions,
   2. appropriate medical management (e.g., thyroid supplementation, antibiotics), and
   3. referral for specialized care if indicated (e.g., fine-needle aspiration, core needle biopsy, open biopsy).