Bilateral Neck Lumps, Moving with Swallowing but Not with the Tongue

CLINICAL DIAGNOSIS MANUAL

Bilateral neck lumps that move with swallowing but not with the tongue are generally related to the thyroid gland. This characteristic movement is due to the anatomical connection of the thyroid gland with the trachea and other neck structures, allowing it to shift during swallowing.

These masses can have various aetiologies, ranging from benign conditions to autoimmune and neoplastic disorders. It is essential to conduct a thorough clinical evaluation and appropriate complementary tests to identify the underlying cause.

Below are the associated symptoms and clinical signs, recommended diagnostic tests, and a list of pathologies that may present with this clinical feature.

Pathology	Symptoms and Clinical Signs	Diagnosis of Suspicion	Diagnosis of Confirmation
Graves’ Disease	Weight loss, nervousness, palpitations, heat intolerance, excessive sweating. Diffuse goitre, prominent eyes (exophthalmos), moist skin, tachycardia.	Clinical history and physical examination. Thyroid function tests (TSH, T3, T4): Elevated T3 and T4, suppressed TSH.	Anti-TSH receptor antibodies (TRAb): Positive. Thyroid scan: Diffusely increased uptake.
Hashimoto’s Thyroiditis	Fatigue, weight gain, cold intolerance, constipation, dry skin. Firm, non-tender goitre, slow heart rate, myxoedema.	Clinical history and physical examination. Thyroid function tests (TSH, T3, T4): Elevated TSH, low or normal T4 and T3.	Anti-thyroid antibodies (anti-TPO, anti-thyroglobulin): Positive. Thyroid ultrasound: Heterogeneous, hypoechoic goitre.
Simple Goitre	Feeling of pressure in the neck, difficulty swallowing. Symmetrical enlargement of the thyroid gland, usually painless.	Clinical history and physical examination. Thyroid function tests (TSH, T3, T4): Normal.	Thyroid ultrasound: Symmetrical enlargement of the thyroid without significant nodules.
Toxic Multinodular Goitre	Weight loss, nervousness, palpitations, heat intolerance. Asymmetrical enlargement of the thyroid gland with multiple palpable nodules.	Clinical history and physical examination. Thyroid function tests (TSH, T3, T4): Elevated T3 and T4, suppressed TSH.	Thyroid scan: Heterogeneous uptake with areas of hyperactivity.
Non-Toxic Multinodular Goitre	Feeling of pressure in the neck, difficulty swallowing. Asymmetrical enlargement of the thyroid gland with multiple palpable nodules.	Clinical history and physical examination. Thyroid function tests (TSH, T3, T4): Normal.	Thyroid ultrasound: Multiple nodules with asymmetrical enlargement.
Thyroid Enzyme Deficiency	Hypothyroidism (fatigue, weight gain, cold intolerance) or hyperthyroidism (weight loss, nervousness, palpitations). Diffuse or nodular goitre, variable thyroid function.	Clinical history and physical examination. Thyroid function tests (TSH, T3, T4): Vary according to the type of enzyme deficiency.	Genetic studies: To identify the type of enzyme deficiency. Thyroid scan: May show altered uptake depending on the type of deficiency.