Robert D. Mercer, M.D.
Department of Pediatrics and Adolescent Medicine
The long and graceful female neck is not ordinarily a problem in differential diagnosis. When there is associated lordosis of the cervical spine, the reversed “C” or swan-like configuration can make the normal anterior neck structures so prominent as to be confused with thyroid enlargement. A simple physical examination should resolve any questions, but the fact that we have had four such young persons referred for “goiter” prompts this report.
Case 1. A girl, 10 years and 6 months of age, was examined at the Cleveland Clinic in 1972 with a chief complaint of an “enlarged thyroid.” Her thyroid gland had been thought to be enlarged for the past 3 years. The possibility of a thyroid neoplasm had been considered and surgical exploration had been suggested. Previous studies included a T3 value of 28% in 1969, 30% in 1970, and 28% in 1971; protein bound iodine was 4.7 /ig/100 ml in 1969 and 4.9 μg/100 ml in 1970. Several roentgenograms and an esophagogram had been performed and were said to have been normal. Otherwise her history was that of a normally active person. There were no complaints and her school work was superior.
Results of general physical examination were normal except for a prominence of anterior neck structures. This prominence disappeared when she was instructed to hold her neck straight. There was no sign of hyperthyroidism or hypothyroidism. Additional laboratory tests were not thought to be necessary. A roentgenogram of the neck was obtained to document the cervical lordosis (Fig. 1),. . .