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Forum Name: Dermatology Topics

Question: Swollen Left Side of Adam's Apple


 RyanUSVI - Wed Mar 03, 2010 3:11 pm

First and foremost I thank you for your time. I am a 27 year old male residing in St Thomas in the United States Virgin Islands. We are considdered part of the US but the health care is certianly not as good. Prior to visiting a Physician I was hoping that I could figure this out with the help of other MD/DO etc. My simptoms are as follows. Toward the end of the day yesterday I noticed that the left side of my Adams apple was slightly swollen and I had a slight pain occur when swallowing. We recently had a volcano erupt on a different Island and there was some fallout in the air so I figured that was the cause. I drank a orange smoothy and used the cup to "ice" the area when not drinking. This morning I awoke with the area much much larger (it is noticable 20 feet away) and it is quite painfull to swallow. If I palpate the area it hurts from the top of the neck, which is where the area now starts all the way down to the start of my sternum and is rougly 2" wide in the center but is oval shaped. I am not running a fever, on any meds, my breathing is not affected, speach is normal, no difference in skin color, I feel fine other than swallowing and touching of siad area. Hope that is enough info. Once again I thank you for your time.

Ryan
 RyanUSVI - Thu Mar 04, 2010 5:43 pm

I decided to make an appointment this morning with a local physician. After a quick examination of the normal blood pressure, temperature, hight, weight, etc. He then took a look at my area of interest he then asked how long it took to develope into this size. I responded with the truth of roughly 24 hours and he just starred at me. He then rattled off a bunch of possibilities and then negated each due to the hardness and density of the swollen area as well as rapid progression. He then stated quite honestly that he can't make a proper diagnosis. They drew 5 vials of blood and I have an appointment on Monday for a CT scan with contrast. I would love some imput but if none comes I will continue to post my progress so that maybe this will be a help to someone in the future.
 Dr.M.Aroon kamath - Wed Mar 10, 2010 8:04 pm

User avatar Hi,
The history you have provided is highly suggestive of an acute/sub-acute thyroiditis(an inflammatory involvement of the thyroid gland).

Thyroiditis may be classified in a number of ways.

- acute,
- sub-acute &
- chronic.

- auto-immune &
- non auto-immune.

- goitrous &
- non-goitrous.

- painful &
- painless.

The thyroid gland is generally resistant to infection
because of its rich vascularity and high iodine content in its follicles.

There are two types of thyroiditis (discussed below)that merit consideration in your case based on the information provided.

Trauma or sepsis may allow the micro-organisms to invade the gland. In acute suppurative thyroiditis, most cases are due to Gram positive microbes. Most commonly begins as a minor viral illness such as the flu or a cold followed by pain and swelling in the region of the thyroid gland. Sometimes only one lobe of the gland is affected resulting in pain and swelling on one side of the neck rather than of both.Generally, there is an initial hyperthyroid phase, followed by normal thyroid hormone levels.In a minority, hypothyroidism may ensue.

In De Quervain’s thyroiditis,(subacute thyroiditis or Granulomatous thyroiditis), a number of viruses such as Influenza virus, Epstein- Barr virus, Adenovirus, Mumps virus,Coxsackievirus, Echovirus and Enterovirus have been implicated.

Presentation may be acute or a subacute (more
common in middle aged women) and is preceded by a
viral prodorome consisting of fever, myalgias, lassitude, sore throat and dysphagia, following which a painful, tender enlargement of the thyroid gland apperars. It is a self- limiting disorder and about a third of the patients may be asymptomatic. The T3, T4 levels and ESR are raised initially and radio-active iodine uptake shows subnormal values.This condition differs from autoimmune thyroiditis in that the thyroid antibodies are absent. Eventual recovery is invariably complete and dramatic response to prednisolone is usual.Occasionally,
thyroid hormones are administered to provide rest to the gland and may be required on a long term basis in prolonged hypothyroid states. Recurrences are uncommon.

Although these types of thyroiditis are far more common in women,they must be considered in men as well.I suggest that you should consult your doctor who would be in a better position to guide you in the diagnosis and management.
Best wishes!
 RyanUSVI - Thu Mar 11, 2010 8:27 am

I had my blood drawn and sent into the local lab. It looks like they only ran a basic pannel I only have 2 items out of normal range which is my MCH level at 34.3 and my T3 uptake at 36. Does that help with diagnosis. I understand that it is dificult to aid in my issues seeing that all the info is done via posts but in the event that I need any major treatment ie surgery I am going to book a flght state side. Thank you again for your time.
 Dr.M.Aroon kamath - Fri Mar 26, 2010 8:25 am

User avatar Hi,
It may not be wise to try to guess something based on a few blood reports.You should better wait for the diagnosis to emerge at the conclusion of all the tests. Good luck!
 Animom70 - Fri Jun 25, 2010 4:08 pm

I can say, from experiance, that thyroid disease can present with a swollen, sided adams apple, this is a nodule and you should most definately have a COMPLETE thyroid panel done, this is a TSH, T3, and T4 blood test. Also, an iodine uptake can find out. Good luck.
 Dr.M.Aroon kamath - Sun Jul 04, 2010 1:44 pm

User avatar Hi Animom70,

Thank you for your views. I certainly concur with what you have said. good day!

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