[32F] With large neck mass and systemic symptoms

Patient Description

A 32-year-old female presents with a large, soft mass on the back and front of her neck, present since early childhood. The mass has many skin tags, is discolored, and has grown significantly larger over time. The patient sometimes experiences pain in the front of the mass but denies any difficulty swallowing or breathing. There are no changes in the skin over the mass, such as redness, warmth, or ulceration, and no numbness or tingling in the area. The patient reports unexplained weight gain throughout her life, decreased energy levels, thinning hair on her head, and excessive hair growth on her face. She has a family history of diabetes and has experienced irregular menstrual cycles all her life. Her medical history includes asthma, vitamin D deficiency, Cushing syndrome, diabetes, and hypothyroidism. Current medications include Levothyroxine (0.075mcg daily), Metformin (1000mg once daily), Lantus Solo Star (60 units once daily), Simvastatin (20mg once nightly), and Trulicity. No known drug allergies.

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Arora's Assessment

What might be happening

Based on the information provided, here are some possible explanations for your symptoms:

  1. Cushing Syndrome: Given your diagnosis of Cushing syndrome, many of your symptoms, such as weight gain, thinning hair on your head, excessive hair growth on your face, and decreased energy levels, could be related to this condition. Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long time. This can lead to a variety of symptoms, including the ones you are experiencing.

  2. Lipoma or Benign Tumor: The large, soft lump on your neck that has been present since childhood and has grown over time could be a lipoma, which is a benign (non-cancerous) tumor made of fat tissue. Lipomas are usually soft, movable, and painless, although they can sometimes cause discomfort if they press on nearby structures.

  3. Thyroid Disorder: Given your history of hypothyroidism and the location of the lump, it is also possible that the lump could be related to a thyroid disorder, such as a goiter (enlarged thyroid gland). Thyroid disorders can cause a variety of symptoms, including weight changes, changes in energy levels, and changes in hair growth.

What you can do

Cushing Syndrome:

  • Follow up with your healthcare provider to discuss the results of your Cushing syndrome testing and to develop a treatment plan. Treatment may include medications, surgery, or other interventions to reduce cortisol levels.
  • Monitor your symptoms and keep a journal of any changes or new symptoms using the MDandMe app. This can help your healthcare provider track your progress and adjust your treatment plan as needed.

Large Lump on Neck:

  • Schedule an appointment with your healthcare provider to have the lump evaluated. They may recommend imaging studies, such as an ultrasound or MRI, to determine the nature of the lump and whether any further treatment is needed.
  • Avoid any activities that cause pain or discomfort in the area of the lump.

General Health:

  • Maintain a healthy diet and exercise regularly to help manage your weight and improve your energy levels.
  • Take your prescribed medications as directed and follow up with your healthcare provider regularly to monitor your chronic conditions, such as diabetes and hypothyroidism.

What you should look out for

Seek medical attention if you experience any of the following:

  • Rapid growth or changes in the lump, such as increased pain, redness, warmth, or ulceration.
  • Difficulty swallowing or breathing.
  • Unexplained weight loss or other new symptoms that concern you.

Remember, it is important to consult with a healthcare provider to receive a formal diagnosis and appropriate treatment. If you have any additional questions or concerns, please feel free to continue the conversation.

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5 mo ago

People Also Ask


What are the common symptoms of Cushing syndrome?

Common symptoms of Cushing syndrome include weight gain, particularly around the abdomen and face, thinning skin, easy bruising, muscle weakness, fatigue, high blood pressure, and changes in mood. It can also cause thinning hair on the head and excessive hair growth on the face.


What is a lipoma and how is it treated?

A lipoma is a benign tumor made of fat tissue that is usually soft, movable, and painless. Treatment is often not necessary unless the lipoma is painful, growing, or causing cosmetic concerns. In such cases, surgical removal may be recommended.


How can thyroid disorders affect weight and energy levels?

Thyroid disorders, such as hypothyroidism, can lead to weight gain and decreased energy levels due to a slowed metabolism. The thyroid gland regulates many body functions, and imbalances can affect overall energy and weight management.


What should I do if I notice changes in a lump on my neck?

If you notice changes in a lump on your neck, such as rapid growth, increased pain, redness, warmth, or ulceration, you should seek medical attention promptly. These changes could indicate an underlying issue that needs evaluation by a healthcare provider.


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