Differential movement during swallowing as an aid in the detection of thyroid pseudonodules

The clinical examination of neck masses is clearly imperfect and false-positive detection of thyroid nodules, termed "pseudonodules," remains a common problem. Movement on swallowing has been emphasized as a highly specific feature of thyroid masses, but lesions in the vicinity of the thyroid can be displaced by underlying structures during deglutition, causing them to mimic thyroid nodules. Two cases are presented to illustrate how additional features of neck mass movement can help determine whether a lesion is located within the thyroid or whether it is extrathyroidal. These include the range of motion of the mass, the presence or absence of a stationary phase prior to descent, and the timing of the movements of the mass. Assessment of these parameters during the physical examination of anterior neck masses may help reduce the incidence of thyroid pseudonodules.