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Swollen lymph nodes in the submental, submandibular and upper thyroid region, CBC normal. Done endoscopy, ultrasound. Help?

I have swollen lymph nodes in the submental, submandibular and now what might be the upper thyroid region... all on the left-side of the neck. I am a 41 year old female. I have no signs of infection and both an office scope and an endoscopy have turned up nothing. My CBC is normal. Ultrasound 35 days ago (when the first node was noticed)) showed a 1cm x .3cm x 1cm normal appearing submental lymph node and a mildly heterogeneous thyroid gland with the left side slightly larger. No lesions or increased vascularity. Some mild discomfort when swallowing (in exact area of lymph nodes in submandibular region) for 9 months and approximately 5 night sweats in those 9 months (shirt and back of neck wet; no drenched sheets). Nodes are too small for needle biopsy. At what point should one do an surgical biopsy? What should I be doing besides waiting???
Asked On : Fri, 12 Apr 2013
Answers:  2 Views:  157
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Endocrinologist 's  Response
If progressively increase the size of the node or thyroid, family history of thyroid ca, presence of hypertension (MEN 2B syndrome), compressive symptoms like dysphagia and dyspnoea, or age of >45 yrs chance of malignancy risk is high. FNAC and biopsy of neck nodes if accesible in future, Serum Calcitonin, CT - Neck and periodic usg neck will be useful.
Answered: Tue, 2 Jul 2013
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Internal Medicine Specialist Dr. Arindam Ray's  Response
ok...for neck nodes,its better to do a FNAC as early as possible,if size is small,biopsy can be done...palpate other parts of body for lymphnodes(axilla,groins)....for lymphnodes resticted to neck-nasopharynx and thyroid to be taken in grater respect....for generalised lymphadenopathy-infection(specially HIV,TB ),lymphoma can be in first examine her properlyand do a surgical biopsy/FNAC with USG of neck first....
Answered: Wed, 3 Jul 2013
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