Dysphagia with a thyroid nodule: is there a primary aerodigestive malignancy?

Abstract

SummaryThree cases of laryngopharyngeal primary squamous cell carcinoma presenting with thyroid nodules are described.The key message to take away from these cases is that patients with advanced malignancy of the upper aerodigestive tract can present with a thyroid nodule. Case series Case 1An 83-year-old woman presented with a sixmonth history of progressive dysphagia, hoarseness, weight loss and a left-sided neck lump. Examination revealed a hard thyroid mass moving on swallowing. Ultra-sound scan confirmed a 2 cm mass in the left thyroid lobe. Fine needle aspiration cytology (FNAC) showed metastatic squamous cell carcinoma. Barium swallow and subsequent pharyngoscopy under general anaesthesia showed a malignant stricture of the cervical oesophagus. Palliative radiotherapy was declined by the patient, who died two months later. Case 2A 60-year-old woman presented with a six-week history of a right-sided neck lump, dysphagia, hoarseness, weight loss and aspiration when drinking. On examination, there was a right lower neck mass and right vocal cord palsy. FNAC was non-diagnostic. An MRI scan showed a mass arising in the right lobe of thyroid encasing the carotid sheath and brachiocephalic artery (Figure 1). Open biopsy of the mass showed moderately differentiated squamous cell carcinoma. Endoscopy under general anaesthesia showed a small supraglottic carcinoma. Palliative chemotherapy was declined and the patient died six weeks later. Case 3The family of the third case, that of a small supraglottic cancer metastasising to the thyroid, would not give consent to publication of further clinical details.

Swallowing Disorders in Cervical Facial Tumors

“…There are documented cases in which a large goiter can compress the esophageal inlet and thus lead to dysphagia. A consistent amount of time should be allotted to cranial nerves exam along with a complete neurology consult [20].…”