Neck Discomfort: Lymph Nodes and Thyroid Concerns

Lymph nodes and the issue of numbness in the front side of the neck?

Hello Doctor: I have a few questions to ask.
Initially, I went to see a doctor because I was experiencing a "full" and "numb" sensation in the front of my neck.
After several visits, no clear cause was identified.
Eventually, I underwent a thyroid ultrasound, which revealed a 0.9 cm nodule on the left side.
The doctor mentioned that its shape appeared normal, but it was too small for a biopsy, and I should follow up in three months.
I am very worried, and after researching online, I found that it could potentially lead to lymphadenopathy.
I immediately checked for lymph nodes in my neck and discovered small lumps on both sides (not sure if they were there before).
The next day, I went to National Taiwan University Hospital to see an ENT specialist, who performed an ultrasound and found lymph nodes on both sides measuring about 1.5 to 1.6 cm.
A few subcentimeter lymph nodes were also found under my chin.
Upon examining my oral cavity, the doctor noted a swollen lymph node in the oropharynx (which has been present for about two weeks), suggesting lymphadenopathy likely due to chronic pharyngitis.
I consulted several doctors, and they all said the lymph nodes looked fine and that observation was sufficient.
However, due to my anxiety, I underwent a 128-slice whole-body CT scan (which I heard is the latest CT technology that can detect tumors larger than 0.3 cm).
After the scan, the doctor reported no tumors or concerning findings, although several lymph nodes were noted.
While I felt somewhat relieved, the sensation of fullness and numbness in my neck persists.
I would like to know if there are any neck cancers that could cause this sensation in the front of my neck? Additionally, should I consider having one of the lymph nodes biopsied for further evaluation?

alan, 20~29 year old female. Ask Date: 2010/04/01

Dr. Chen Sirong reply Oncology

1.
I understand that your concerns are reasonable.

2.
You have already undergone appropriate examinations.

3.
Currently, there are no issues with your health.

4.
The tingling sensation may be related to the spinal nerves, but it is rarely due to a tumor.

5.
Given the current situation with the lymph nodes not continuing to grow, I do not recommend removing one for biopsy.
Do you really want to have a scar at such a young age? Removing just one node may not be sufficient; what if another problematic node is left unexamined?

Reply Date: 2010/04/01

More Info

Neck discomfort, particularly in the context of thyroid nodules and lymph nodes, can be a source of significant anxiety for many patients. Your symptoms, including the sensation of "fullness" or "numbness" in the front of your neck, along with the discovery of a thyroid nodule and lymph nodes, warrant careful consideration and follow-up.

Firstly, it's important to understand that thyroid nodules are quite common, and the majority are benign. The fact that your ultrasound showed a 0.9 cm nodule with a shape that appears normal is reassuring. Most guidelines suggest that nodules under 1 cm, especially those that are not suspicious in appearance, can often be monitored with follow-up imaging rather than immediate biopsy. Your physician's recommendation to wait three months for a follow-up ultrasound is standard practice in such cases.

The presence of lymph nodes in your neck, particularly if they are small and mobile, is also common and often not a cause for concern. Lymph nodes can become reactive due to various benign conditions, such as infections or inflammation, including chronic pharyngitis, which you mentioned. The ultrasound findings of lymph nodes measuring around 1.5-1.6 cm are generally considered within normal limits, especially if they are not hard, fixed, or associated with other concerning features.

Regarding your concern about neck cancer causing the sensations you are experiencing, it is essential to note that while cancers can cause discomfort or unusual sensations in the neck, they typically present with additional symptoms, such as significant weight loss, persistent pain, or changes in voice. The sensations you describe could be related to muscle tension, anxiety, or even referred sensations from other areas, such as the throat or jaw, rather than a direct result of malignancy.

As for the lymph nodes, the decision to biopsy or remove a lymph node is typically based on specific criteria, including size, consistency, and whether there are any concerning features on imaging or physical examination. If your lymph nodes are stable and not exhibiting any suspicious characteristics, your doctors may recommend continued observation rather than surgical intervention.

In summary, while your symptoms and findings understandably raise concerns, the current evidence suggests that there is no immediate cause for alarm. It is crucial to maintain open communication with your healthcare providers, follow their recommendations for monitoring, and report any new or worsening symptoms. If your discomfort persists or worsens, further evaluation may be warranted, including potential referrals to specialists such as an endocrinologist or an ENT (ear, nose, and throat) specialist for a more comprehensive assessment.

In the meantime, consider discussing your anxiety and discomfort with your healthcare provider. They may suggest strategies to help manage your symptoms, including relaxation techniques, physical therapy for neck discomfort, or even counseling to address anxiety related to your health concerns. Remember, you are not alone in this process, and there are resources available to support you.

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