HomeAnswersEndocrinologyneck painRadiating neck pain and jaw pain while swallowing. Need help.

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

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Shaikh Sadaf

Medically reviewed by

iCliniq medical review team

Published At January 25, 2023
Reviewed AtOctober 16, 2023

Patient's Query

Hello doctor,

I have pain in the right lower side of the neck which gets aggravated if touched. It has been like this for the past seven to eight days. Sometimes the pain radiates to the jaw and also causes headaches. The pain gets controlled by taking Ibuprofen and Paracetamol. I also have had a low-grade fever in the morning and evening for the past three to four days. I feel discomfort or pain when swallowing and drinking, and lethargy (low energy) is present. I take multivitamins, fish oil, iron, and vitamin D supplements. Please help.

Answered by Dr. Shaikh Sadaf

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.

Patient's Query

Hello doctor,

Thank you for your reply.

The ultrasound report says no cervical lymphadenopathy. I was just wondering if it indicates enlarged lymph nodes. So please let me know about this. And we could start the antibiotic straight away.

Answered by Dr. Shaikh Sadaf

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.

Patient's Query

Hello doctor,

Thank you for your reply.

Please find the image of the neck from the anterior and lateral sides. I have put an arrow pointing to the exact location of the pain. No obvious swelling when observed, but it can be felt when palpated.

Answered by Dr. Shaikh Sadaf

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.

Patient's Query

Hi doctor,

Thank you for your reply.

I have attached the report of the CT scan of the neck (with contrast). Results appear normal with no mass. And like you said, the local GP also stated that it was likely subacute thyroiditis and wanted to consider steroids for quicker healing. So let me know the tapering dosage for Prednisolone so we can start the medicine.

Answered by Dr. Shaikh Sadaf

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.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shaikh Sadaf
Dr. Shaikh Sadaf

Endocrinology

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