The front half of my neck feels tight

Discomfort in the front of the neck is usually considered to be related to the thyroid gland, possibly due to thyroiditis or thyroid nodules. In this case, the general treatment method is to first apply hot compress, then go to the general surgery department for a thyroid color ultrasound examination, and also have a blood test for thyroid function. You need to fast before the blood test, and the treatment plan will be decided based on the results.

Thyroid nodules

1. Nodular goiter

It is more common in middle-aged women. When the body's thyroid hormone is relatively insufficient, the pituitary gland secretes more TSH. Under the long-term stimulation of this increased TSH, the thyroid gland undergoes repeated or continuous hyperplasia, leading to uneven enlargement and nodular changes in the thyroid gland. There may be hemorrhage, cystic changes and calcification within the nodule. The size of the nodules can range from a few millimeters to several centimeters. The main clinical manifestation is thyroid enlargement. Multiple nodules of varying sizes can be felt during palpation. The texture of the nodules is mostly of medium hardness. A few patients can only palpate a single nodule, but multiple nodules are often found during thyroid imaging or surgery. Patients do not have many clinical symptoms, generally only discomfort in the front of the neck, and thyroid function tests are mostly normal.

2. Nodular toxic goiter

The disease has a slow onset and often occurs in patients who have had nodular goiter for many years. The age is mostly over 40 to 50 years old, and it is more common in women. It may be accompanied by symptoms and physical signs of hyperthyroidism, but the symptoms of hyperthyroidism are generally mild, often atypical, and infiltrative exophthalmos generally does not occur. When palpating the thyroid gland, a smooth round or oval nodule can be felt with clear boundaries and a hard texture. It moves up and down with swallowing, and there is no vascular murmur in the thyroid gland area. Thyroid function tests show elevated thyroid hormone in the blood, which is caused by functional autonomous nodules, and radionuclide scanning shows "hot nodules".

3. Inflammatory nodules

It is divided into infectious and non-infectious types. The former is mainly subacute thyroiditis caused by viral infection, while other infections are rare. In addition to thyroid nodules, subacute thyroiditis is clinically accompanied by fever and local thyroid pain. The size of the nodules depends on the extent of the lesions and the texture is tough. The latter is mainly caused by autoimmune thyroiditis, which is more common in middle-aged and young women. Patients have fewer subjective symptoms. Multiple or single nodules can be palpated during examination. The texture is hard and tough, with little tenderness. Thyroid function tests often show strongly positive thyroglobulin antibodies and thyroid microsomal antibodies.

Thyroiditis

1. Hashimoto’s thyroiditis

That is, chronic lymphocytic thyroiditis. The peak age of onset is 30 to 50 years old, and the incidence rate in women is 15 to 20 times that in men. The onset is slow, and when the disease occurs, there is often an enlarged thyroid gland with a hard and tough texture, a nodular surface, and clear boundaries. There is often pharyngeal discomfort or mild difficulty in swallowing, and some patients may have compression symptoms. There is often no special feeling in the early stage, and the thyroid function may be normal. A small number of patients may have transient hyperthyroidism symptoms in the early stage, and in most cases, hypothyroidism has already occurred when it is discovered. Patients often experience symptoms such as fear of cold, edema, fatigue, dry skin, abdominal distension, constipation, irregular menstruation, and decreased libido. A small number of patients may develop thyroid-related eye disease. Some patients may present with coexistence of Hashimoto's thyroiditis and Graves' disease, clinically manifested by alternating symptoms of hyperthyroidism and hypothyroidism.

2. Subacute thyroiditis

This disease is self-limiting and is the most common thyroid painful disease, which is more common in middle-aged women aged 30 to 50 years old. The typical manifestation is severe pain in the thyroid gland. Usually the pain starts on one side of the thyroid gland and quickly radiates to other parts of the gland, the ear base, and the jaw. It is often accompanied by general discomfort, fatigue, muscle pain, and fever. The pain reaches a peak within 3 to 4 days after the onset of the disease and subsides within 1 week. There are also many patients who have a slow onset, which lasts more than 1 to 2 weeks. The condition fluctuates for 3 to 6 weeks. After improvement, there may be multiple relapses within a few months. The thyroid gland may increase in size by 2 to 3 times or even larger than normal, and there is obvious tenderness when touched. Within one week after the onset of the disease, about half of the patients will have symptoms of hyperthyroidism, such as excitement, heat intolerance, palpitations, tremors and sweating. These symptoms are caused by excessive release of thyroid hormones from the thyroid gland during acute inflammation. During the course of the disease, a small number of patients may experience symptoms of hypothyroidism such as swelling, constipation, chills, and drowsiness, but these symptoms do not last long and the thyroid function eventually returns to normal.

3. Painless thyroiditis

The disease can occur at any age, but is more common in women aged 30 to 50. Typically, changes in thyroid function are divided into three stages: thyrotoxicosis, hypothyroidism, and recovery. The symptoms of the thyrotoxic stage include sudden onset of nervousness, heat intolerance, tachycardia, and weight loss. In some cases, thyrotoxicosis is not obvious at the beginning, and hypothyroidism is the clinical manifestation. The hypothyroidism period lasts for 2 to 9 months and then gradually returns to normal. Some patients have persistent hypothyroidism, and 10% to 15% of patients may relapse after 10 years. About half of the patients have mild diffuse enlargement of the thyroid gland, which is hard in texture, without nodules, pain or tenderness.

4. Postpartum thyroiditis

Occurring within one year after delivery, the patient's thyroid gland may be slightly to moderately enlarged, with a medium texture and no tenderness. The typical clinical course is biphasic hyperthyroidism and hypothyroidism. The hyperthyroidism stage occurs within six months after delivery and lasts for 1 to 2 months, with symptoms such as palpitations, emotional agitation, heat intolerance, fatigue, etc. The hypothyroidism stage occurs 3 to 8 months after delivery and lasts 4 to 6 months, with symptoms such as fatigue, inattention, constipation, muscle and joint pain and stiffness. The recovery period occurs 6 to 12 months after delivery, and about 20% of patients may have persistent hypothyroidism.