The berry ligament is a key factor in preventing the thyroid gland from sinking into the mediastinum. When the thyroid gland enlarges, it can cause difficulty swallowing or dysphagia due to direct compression of the organs involved in swallowing. This enlargement, which is usually about a quarter of its size, can be a symptom of several thyroid disorders as well as other medical conditions. Studies have shown that up to 33% of patients with benign goiter report difficulty swallowing and shortness of breath. When feeling for the thyroid, it is important to note that the thyroid cartilage is not where the gland is located.
It is the area in front of the neck that moves up and down when you swallow, commonly referred to as the Adam's apple in men. Evaluation of these parameters during physical examination of anterior neck masses can help reduce the incidence of thyroid pseudonodules. If the cause is an enlarged thyroid, dysphagia can worsen if the nodules continue to grow or if the thyroid condition progresses. The classic presentation is a palpable, midline, non-sensitive mass that moves with swallowing and rises when the tongue protrudes. When the thyroid gland becomes significantly enlarged, it can begin to compress the esophagus (and other nearby structures such as the trachea), which can cause dysphagia and breathing difficulties in some cases.
If the enlargement is large enough to cause symptoms of compression, your doctor may be able to identify it by feeling your neck area during swallowing. Goiter (sometimes spelled goiter) is an inflammation of the thyroid gland that causes a lump in the front of the neck. In cases of thyroid inflammation, your doctor may prescribe medications to reduce swelling of the thyroid and problems with swallowing. The mass in the neck moves during swallowing or in the protrusion of the tongue due to its attachment to the tongue through the descent tract of the thyroid. Classically, it presents as a swelling of the neck in the anterior midline that moves with both swallowing and protrusion of the tongue. Some children with thyroid nodules have pain in their front neck or feel like they have a lump in their throat.
Hashimoto's thyroiditis leads to symptoms of an underactive thyroid gland (hypothyroidism), such as tiredness, weight gain, and dry skin. The common presentation is swelling of the midline of the neck, which moves with both protrusion of the tongue and swallowing. Clinical examination of cervical masses is clearly imperfect and false-positive detection of thyroid nodules, called pseudonodules, remains a common problem. Thyroid examination is important, as it is often the first step in diagnosing thyroid diseases such as Graves disease, Hashimoto's thyroiditis, and multinodular goiter.
