What could be the cause of radiating neck pain, low-grade fever, and pain while swallowing?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

From what you have attached (attachment removed to protect the patient's identity), you have enlarged lymph nodes due to an inflammatory reaction in your body. It appears to be an infection of either your throat or your lungs. If you are not allergic to penicillin and not pregnant, I suggest you take the tablet Augmentin 1 g (Amoxicillin + Clavulanic acid) twice daily for a week. However, please consult a physician, discuss with them and start taking the medications with their consent.

As for the incidental thyroid nodule, it is very small to be measured, let alone for a biopsy. So we will repeat an ultrasound thyroid gland from another place different from the current one after three months. Repeat a thyroid function test every three months or if you have any new symptoms like a racing heart, feeling unusually hot or cold, restlessness, panic, or scanty periods. The present problem is not related to your thyroid gland but an infection. I would also suggest you test for COVID too. Also, since you have fatty liver and raised triglycerides, you must do intermittent fasting to correct the issue. A low-carbohydrate and low-fat diet should help reduce it.

Hope this helps.

Thank you and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Can you take a picture of the neck pointing to the location exactly? Unfortunately, the ultrasound was not very beneficial in deciding on any thyroid disorder or otherwise.

Hope this helps.

Thank you and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Yes, it seems to be related to the thyroid gland, but it is called subacute thyroiditis, which means inflammation of the thyroid gland. Subacute thyroiditis is presumed to be caused by a viral infection or a postviral inflammatory process. You must have had an upper respiratory tract infection four to eight weeks ago, after which this started occurring. Whatever factors initiate subacute thyroiditis, the resulting thyroid inflammation damages thyroid follicles. So as the inflammation subsides, the thyroid follicles regenerate, and thyroid hormone synthesis and secretion resume. There is usually a period of rapid evolution through euthyroidism (normal thyroid function tests) and hypothyroidism (under-functioning of the thyroid gland). Hypothyroidism lasts until the thyroid gland can generate sufficient thyroid hormone synthesis and secretion, and then the gland regains normal homeostasis (normal functions). Each phase typically lasts two to eight weeks, except for the initial transition through euthyroidism, which may be shorter. Recovery is nearly always complete.

I would suggest the following treatment plan.

1. Tablet Naproxen 500 mg twice daily for seven days (if not allergic and if no gastric problems exist).

2. Tablet Omeprazole 20 mg twice daily for seven days. If there is no relief in two to three days, please revert back immediately for further evaluation of the treatment plan.

3. Stop taking the tablet Augmentin (Amoxicillin+Clavulanic acid).

5. Rest properly during this period, and avoid alcohol and junk food. Eat and sleep well.

6. Repeat the thyroid function test in six weeks and revert for further management.

However, please consult a physician, discuss with them and start taking the medications with their consent.

Hope this helps.

Thank you and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I saw your CT (computed tomography) scan reports (attachments removed to protect the patient's identity). It suggests osteoarthritis at the site of your swallowing difficulties, meaning a small part of the cervical vertebrae is protruding within. The thyroid gland is not enlarged. Subacute thyroiditis is the best diagnosis based on your symptoms.

If your pain has not improved and the neck discomfort is more severe in the context of significant systemic symptoms, starting the tablet Prednisone (40 mg daily) as initial therapy is reasonable. Prednisone therapy should result in pain relief in one to two days; if not, the diagnosis should be questioned. The clinical response will determine the duration of steroid therapy. Once the pain is relieved by Prednisone, an attempt should be made to find the lowest possible dose that provides adequate pain relief by reducing the dose by 5 to 10 mg every five to seven days. Should pain reoccur, increase the initial dose and maintain that dose for approximately two weeks, then attempt to taper again. Typically, a two to eight-week course of Prednisone is required, and occasionally, the course may be even more prolonged.

Please be aware that steroids have a wide range of side effects, such as high blood sugar, high blood pressure, osteoporosis, weight gain, gastric ulcers, and many more, and if you have no pain relief with Naproxen, only then attempt to start steroids. You should know this before starting it. However, please consult a physician, discuss with them, and start taking the medications with their consent.

Hope this helps.

Thank you and take care.