Growth in Thyroid Notch

[nih_radioguy]

Hello again... some time ago, you answered a question for me about thyroglossal cysts and thyroid cancer.  You asked me to keep you informed, so here goes...

CT showed my thyroid itself to be just fine.  However, there is a "soft tissue mass" in the notch of my thyroid cartilage "continuing into and silhouetting with the strap muscles".  It does not have cystic attenuation, so the radiologist doesn't believe it is a TGDC.  Also, there is a small enhancing lymph node with central lucency at the hyoid level, slightly to the left.

My ENT doctor didn't think much of this and wants to just sit on it for six months.  My GP disagrees and is calling for another MRI and, if the lesion is large enough, FNAB.  On the original MRI that caught it incidentally, it was 3.4cm tall, 1.4cm front-to-back, 1.0cm side-to-side.  The lymph node looks to be about a centimeter, and it can be seen in three of the CT slides.

Flexible endoscope of the larynx shows nothing pathologic.  This lesion seems to be in the soft tissue in the thyroid notch, proceeding into the strap muscles.

What sort of thing are we looking for?  It's not a cyst, or at least the CT report says it doesn't look like one.  Lymphoma?  Adenoma?  Thanks again!  :)

[Mark Lupo, M.D.]

A central neck mass merits surgery in many cases (esp if it is not clearly an intrathyroidal mass) -  at 3.4cm it is fairly large and now there is a lymph node.  Get a second ENT opinion or at minimum a biopsy.

[nih_radioguy]

BTW -- I neglected to add that the lesion in the thyroid notch is seen in six of the CT images, starting at the notch and ending just posterior to the hyoid bone.

Thanks again!