Thyroid Inflammation: Symptoms and Lymph Node Concerns

Q: Thyroid Inflammation: Symptoms and Lymph Node Concerns

Dear kk： Lymph nodes do not necessarily swell or become painful, and they do not affect the vocal cords. <br>You can visit an otolaryngologist for further examination.

Thyroiditis

Hello, doctor.
During a laryngoscopy, it was found that my left vocal cord moves more slowly, but the closure is complete.
A chest X-ray was normal, and an MRI of the brain and brainstem was also normal.
A neck ultrasound revealed diffuse enlargement of the thyroid gland, with a 3mm nodule at the lower border of the left lobe and a 15mm lymph node in the left carotid region.
Both the nodule and the lymph node are oval-shaped, and due to their small size, the primary physician mentioned that a fine needle aspiration would be difficult and the results might not be accurate.
However, since their shape resembles benign characteristics, I was advised to remain calm.
Subsequently, I had thyroid blood tests, which showed elevated levels of TgAb and TPOAb, indicating possible thyroiditis, and I was instructed to follow up in four months to monitor the situation.

However, in the past week, I have noticed some swelling and tenderness in the submandibular area and on both sides of my neck.
When I palpate the swollen areas, it feels like there are lymph nodes, but they are not large and are mobile, with no tenderness upon pressure.
Since the neck ultrasound two weeks ago did not mention any lymph nodes on the right side, I am a bit concerned that there might be an issue with the lymphatic system.

Could you please tell me if lymph nodes can become swollen and tender during thyroiditis? Can lymph nodes become inflamed? Could this affect vocal cord movement?

Kk, 20~29 year old female. Ask Date: 2015/12/07

Dr. Zhou Jiazhen reply Breast and Thyroid

Dear kk: Lymph nodes do not necessarily swell or become painful, and they do not affect the vocal cords.
You can visit an otolaryngologist for further examination.

Reply Date: 2015/12/07

More Info

Thyroid inflammation, also known as thyroiditis, can indeed lead to various symptoms, including discomfort in the neck and potential involvement of lymph nodes. In your case, the findings from your imaging studies and blood tests suggest that you may be experiencing autoimmune thyroiditis, which is characterized by the presence of antibodies such as thyroglobulin antibodies (TGAB) and thyroid peroxidase antibodies (TPOAB). This condition can lead to inflammation of the thyroid gland, which may manifest as swelling or discomfort in the neck area.

Symptoms of Thyroid Inflammation
1. Neck Discomfort: Patients often report a sensation of fullness or discomfort in the neck, particularly around the thyroid gland. This can sometimes be mistaken for other conditions, such as lymphadenopathy (swollen lymph nodes).

2. Lymph Node Involvement: Inflammation of the thyroid can lead to reactive lymphadenopathy, where the lymph nodes in the neck may become enlarged due to the immune response. This is particularly common in autoimmune conditions. While you mentioned that the lymph nodes you felt were not particularly large and were movable, this is generally a reassuring sign. Pain or tenderness in lymph nodes can occur, but it is not always present.

3. Voice Changes: Thyroid inflammation can potentially affect the voice, especially if the inflammation is significant enough to impact the surrounding structures, including the recurrent laryngeal nerve, which innervates the vocal cords. However, in your case, since the vocal cord closure is complete, it suggests that there is no significant impairment at this time.

Lymph Node Concerns
The presence of enlarged lymph nodes, especially in the context of thyroid inflammation, is often due to the immune system's response to the inflammation. While it is understandable to be concerned about lymphadenopathy, particularly if new nodes have developed since your last ultrasound, the characteristics you described (movable and not tender) are generally indicative of benign processes. However, it is essential to monitor these changes closely, as advised by your healthcare provider.

Follow-Up and Monitoring
Given your situation, it is crucial to adhere to the follow-up plan set by your physician. Regular monitoring through ultrasound and blood tests will help assess the progression of your thyroid condition and any changes in the lymph nodes. If you notice any significant changes, such as increased size of the lymph nodes, new symptoms, or persistent pain, it is important to report these to your healthcare provider promptly.

Conclusion
In summary, thyroid inflammation can lead to symptoms such as neck discomfort and lymph node enlargement. While lymph nodes can become reactive due to inflammation, the characteristics you described are generally reassuring. It is essential to continue monitoring your condition and follow your doctor's recommendations for follow-up care. If you have any further concerns or if new symptoms arise, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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