Unilateral Progressively Growing Neck Mass in a Young Adult

Abstract

An 18-year-old male presented to the primary care physician with a 4-month history of a slowly progressive painless lateral neck mass on the right side. The patient denied any history of dysphagia, dysphonia, drainage, previous neck surgery, trauma, or recent fever. There was no significant medical or family history of thyroid disease. On examination, the mass moved with swallowing. The patient had normal thyroid stimulating hormone and calcium levels and a parathyroid hormone (PTH) level of 63 pg/mL. Neck ultrasonography revealed a well-circumscribed anechoic lesion with a diameter of 5.9 cm in the right thyroid lobe without any internal solid nodularity or septation. A neck computed tomography (CT) scan revealed an intrathyroidal lesion extending inferiorly to 3 cm above the angle of Louis causing tracheal compression and displacement (Figure , A). The patient underwent right hemithyroidectomy to relieve tracheal compression. A near-infrared autofluorescence (NIRAF) camera yielded a homogenously dim lesion (Figure , B). Pathologic examination confirmed a normal right thyroid lobe, a normal right parathyroid gland, and a cystic lesion at the inferior pole with no evidence of malignant disease in the specimen. The tissue inside the lesion stained positive for PTH.