A woman in her 60s was referred for evaluation of a rapidly growing thyroid goiter that coincided with the development of dysphagia, orthopnea, and hoarseness. She denied any constitutional symptoms of hypothyroidism or hyperthyroidism and had no history of irradiation. Physical examination revealed a firm, diffusely enlarged right thyroid with tracheal deviation. An immobile right vocal fold was encountered on laryngoscopy. Ultrasonography showed a 9.7-cm soft-tissue neoplasm arising from the right thyroid lobe engulfing the right common carotid artery and multiple enlarged lymph nodes at level IV of the right side of the neck. Fine-needle aspiration cytology (FNAC) of the thyroid mass demonstrated an adenomatoid nodule. Flow cytometry and FNAC of the level IV node did not show any immunophenotypic abnormality. Computed tomographic images (Figure, A and B) demonstrated a mass in the right lobe of the thyroid with focal calcifications with extension into the parapharyngeal and prevertebral spaces, laryngotracheal deviation, encasement of the right common and internal carotid arteries with obliteration of the internal jugular vein, and enlarged cervical lymph nodes.
Ozgursoy OB, Vuica-Ross M, Agrawal N. Rapidly Enlarging Midline Neck Mass. JAMA Otolaryngol Head Neck Surg. 2015;141(1):85-86. doi:10.1001/jamaoto.2014.2662