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Is It Possible That The Thyroid Inflammation And/or Nodules Could Impact The Salivary Pooling?
Question: I am undergoing work up with an ENT and endocrinologist for suspected subacute thyroiditis. During ultrasound, two nodules were noted. Biopsy will move forward soon.
During an ENT work up, with endoscopy/laryngoscopy, the doctor noted “a moderate amount of pooling of salivary secretions in the piriform sinuses.”
He suggested that this may be caused by esophagitis, for which I have been taking a proton pump inhibitor for years. He noted that otherwise the endoscopy of the upper aerodigestive tract was normal.
I do have a slight bit of horseness, a bit of pain in my right ear that comes and goes, and occasionally a “tickle” feeling in my throat when I inhale deeply that leads to a cough.
I have read about hypopharyngeal cancer being associated with this salivary pooling and am concerned that this may be the case here.
Is it possible that the thyroid inflammation and/or nodules could impact the salivary pooling? Or any esophagitis (although I take between 20-40mg daily of a PPI)? Is there anything reassuring about this finding that should lead me not to assume the worst?
During an ENT work up, with endoscopy/laryngoscopy, the doctor noted “a moderate amount of pooling of salivary secretions in the piriform sinuses.”
He suggested that this may be caused by esophagitis, for which I have been taking a proton pump inhibitor for years. He noted that otherwise the endoscopy of the upper aerodigestive tract was normal.
I do have a slight bit of horseness, a bit of pain in my right ear that comes and goes, and occasionally a “tickle” feeling in my throat when I inhale deeply that leads to a cough.
I have read about hypopharyngeal cancer being associated with this salivary pooling and am concerned that this may be the case here.
Is it possible that the thyroid inflammation and/or nodules could impact the salivary pooling? Or any esophagitis (although I take between 20-40mg daily of a PPI)? Is there anything reassuring about this finding that should lead me not to assume the worst?
Brief Answer:
There is no cause for worry. Proceed with the FNAB/FNAC.
Detailed Answer:
Hi,
1. There is no specific relation between your thyroid and your throat. Thyroiditis, including subacute cases, often presents like this.
2. TIRADS TR4 is mostly benign nodules, and rarely, suspicious for malignancy.
3. The FNAB / FNAC (Fine Needle Aspiration Biopsy/ Cytology) can be done and should be Ultrasound / USG guided for greater accuracy.
4. The issue is that the thyroid gland is itself made up of follicles and hence FNAB/ FNAC reports for normal and malignant conditions look similar. First, a 4D Doppler Ultrasound / USG-guided FNAB/FNAC and then a nuclear Thyroid Scan, if required, can help differentiate the possibility.
5. Most thyroid malignancies are slow-growing and spread locally, hence a delayed diagnosis is not a concern. You have subacute thyroiditis which is not how malignancies present. Regular Thyroid Function Tests are important here and with medication, it will settle over time.
6. At present your diagnosis is MNG (Multinodular Goite) with subacute thyroiditis. MNG is very common in female patients. In males, I insist on an earlier FNAB/FNAC.
7. The pooling of saliva is likely due to your acid reflux and possibly a recent URTI (Upper Respiratory Tract Infection). The nodules have no connection to this.
8. You may share your FNAB/ FNAC reports for further discussion.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards.
There is no cause for worry. Proceed with the FNAB/FNAC.
Detailed Answer:
Hi,
1. There is no specific relation between your thyroid and your throat. Thyroiditis, including subacute cases, often presents like this.
2. TIRADS TR4 is mostly benign nodules, and rarely, suspicious for malignancy.
3. The FNAB / FNAC (Fine Needle Aspiration Biopsy/ Cytology) can be done and should be Ultrasound / USG guided for greater accuracy.
4. The issue is that the thyroid gland is itself made up of follicles and hence FNAB/ FNAC reports for normal and malignant conditions look similar. First, a 4D Doppler Ultrasound / USG-guided FNAB/FNAC and then a nuclear Thyroid Scan, if required, can help differentiate the possibility.
5. Most thyroid malignancies are slow-growing and spread locally, hence a delayed diagnosis is not a concern. You have subacute thyroiditis which is not how malignancies present. Regular Thyroid Function Tests are important here and with medication, it will settle over time.
6. At present your diagnosis is MNG (Multinodular Goite) with subacute thyroiditis. MNG is very common in female patients. In males, I insist on an earlier FNAB/FNAC.
7. The pooling of saliva is likely due to your acid reflux and possibly a recent URTI (Upper Respiratory Tract Infection). The nodules have no connection to this.
8. You may share your FNAB/ FNAC reports for further discussion.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you very much for that thorough and detailed response. It’s one of the best I’ve received.
Just to follow up, I wanted to focus on that laryngoscopic finding of the moderate salivary looking in the pyriform sinuses. As you mentioned (as did the ENT), that is probably related to esophagitis. However, I’ll point out that I’ve been taking pantoprazole for years. Still, I had been alternating between 20mg and 40mg. Be advised me to stay at 40.
It had been my worry, based on some medical journals I had seen, that it was a hypopharyngeal cancer, which I’ve read can cause this. I understand that is relatively rare, and I’m hoping the ENT would have seen something else suspicious if it were some malignancy. Would you agree with that? There just isn’t very much information on the pooling question.
Just to follow up, I wanted to focus on that laryngoscopic finding of the moderate salivary looking in the pyriform sinuses. As you mentioned (as did the ENT), that is probably related to esophagitis. However, I’ll point out that I’ve been taking pantoprazole for years. Still, I had been alternating between 20mg and 40mg. Be advised me to stay at 40.
It had been my worry, based on some medical journals I had seen, that it was a hypopharyngeal cancer, which I’ve read can cause this. I understand that is relatively rare, and I’m hoping the ENT would have seen something else suspicious if it were some malignancy. Would you agree with that? There just isn’t very much information on the pooling question.
Brief Answer:
Details as discussed below:
Detailed Answer:
Hi,
Thank you for following up.
1. Pooling in both pyriform fossae is unlikely to be hypopharyngeal malignancy, more to do with an inflammation/bogginess due to reflux, infection, or in older patients, some neurological problems.
2. It will be helpful to see a video or images from the endoscopy if possible.
3. The further investigations are firstly a repeat Video'laryngoscopy. Then, if required, FEES (Fiberoptic Endoscopic Evaluation of Swallowing), FEESST (Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing), Barium swallow study, Esophageal manometry, Laryngeal USG/Ultrasound, and Scanning are some of the investigations that may be done by your ENT Specialist/Gastroenterologist/ Physician.
4. Are you taking the pantoprazole on an empty stomach? Have any prokinetics been used in the past? Have you done any food allergy or food intolerance tests? Has hiatus hernia, hypochlorhydria, and h. pylori infection been ruled out? What is your BMI (Body Mass Index)? Do you snore or have sleep apnea?
5. Another important point is that the pooling of saliva in the pyriform fossae is not the only sign of a hypopharyngeal malignancy. There are many other signs such as exophytic growths, ulcerations, permanent change in voice, problems with vocal fold movements, difficulty in swallowing, and so on. None of the other findings are seen, which is good. Even your neck sonography does not show any signs suggestive of any other issue besides subacute thyroiditis.
6. The only argument will be an endophytic growth. As I explain to many patients, cancer symptoms will be progressive and unrelenting as compared to other benign pathologies. Also, regular follow-up checks will, in time, reveal any pathology which may have been missed. Hence, instead of stressing over this, keep a watch over the symptoms and get regular surveillance done.
7. Hence if an ENT has seen and cleared malignancy, it is safe to assume that all is in order.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards.
Details as discussed below:
Detailed Answer:
Hi,
Thank you for following up.
1. Pooling in both pyriform fossae is unlikely to be hypopharyngeal malignancy, more to do with an inflammation/bogginess due to reflux, infection, or in older patients, some neurological problems.
2. It will be helpful to see a video or images from the endoscopy if possible.
3. The further investigations are firstly a repeat Video'laryngoscopy. Then, if required, FEES (Fiberoptic Endoscopic Evaluation of Swallowing), FEESST (Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing), Barium swallow study, Esophageal manometry, Laryngeal USG/Ultrasound, and Scanning are some of the investigations that may be done by your ENT Specialist/Gastroenterologist/ Physician.
4. Are you taking the pantoprazole on an empty stomach? Have any prokinetics been used in the past? Have you done any food allergy or food intolerance tests? Has hiatus hernia, hypochlorhydria, and h. pylori infection been ruled out? What is your BMI (Body Mass Index)? Do you snore or have sleep apnea?
5. Another important point is that the pooling of saliva in the pyriform fossae is not the only sign of a hypopharyngeal malignancy. There are many other signs such as exophytic growths, ulcerations, permanent change in voice, problems with vocal fold movements, difficulty in swallowing, and so on. None of the other findings are seen, which is good. Even your neck sonography does not show any signs suggestive of any other issue besides subacute thyroiditis.
6. The only argument will be an endophytic growth. As I explain to many patients, cancer symptoms will be progressive and unrelenting as compared to other benign pathologies. Also, regular follow-up checks will, in time, reveal any pathology which may have been missed. Hence, instead of stressing over this, keep a watch over the symptoms and get regular surveillance done.
7. Hence if an ENT has seen and cleared malignancy, it is safe to assume that all is in order.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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