Question: Dear Dr
For the past 12 months I have had lymph node in my neck on the right side about 3 inches down from my right ear. The node itself is painless, feels rubbery and smooth when I palpate it. I had an ultrasound after 3 months of initial presentation and the results were that whilst it was borderline in size (I believe just under 2cm) that there were no suspicious features and therefore was likely reactive. Whilst performing the check the Sonographer remarked that I had a large thyroid but said no more. Fast forward 8 months and the Lymph node remained the same in size. I had a follow up ultrasound and the Sonographer suggested that whilst it still did not seem suspicious that it was still borderline in size and recommended a skinny needle aspiration to rule out any problems simply because it had been up for so long. He stressed that he did not feel it was suspicious. When I consulted with my ENT doctor he looked at the results and said that he did not think the SNA was necessary so it was left and he said to let my GP know if I had any other symptoms present.

Fast forward to date and the Lymph node is still up. It hasn't grown in size or changed however. In addition in the last 3 months I have also developed what I can only describe as a mass in my throat either side of my XXXXXXX apple. This is not painful but is a definite as it causes wheezing and constriction of breathe at night and also when I work out. It feel like it has reduced my air intake by about 20% at least.

To be precise, the location is either side of and slightly behind my XXXXXXX apple. It is more pronounced on the right hand side. I can move it from side to side and it clicks. To re-confirm, it is noticeably bigger on the right side which is the same side as my swollen lymph.

Whilst painless, this causes constriction and wheezing when I do sport and also at night when i rest my head on my pillow. I can feel my throat against the pillow which causes some constriction and wheezing. I have had NO night sweats, or unexplained weight loss or any change in bowel habits. In fact, I eat a fairly healthy calorie restricted diet and work out for 3 hours per day 4 days per week at a fairly high intensity and am unable to loose any significant weight.

My question is, given the above symptoms firstly, when a Sonographer is looking at the neck lymph nodes can you tell me if they would generally also check things like the thyroid as a matter of course or is this done as a specific separate investigation. How good is ultrasound at picking up anything unusual with the thyroid and in your professional opinion should I at this stage request a skinny needle aspiration of the lymph node as it has remained the same.