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Should I worry about this ?

Hi, I had thyroidectomy in Oct 2017 for pap cancer after 2.5 yrs  asking repeatedly for Ultra Sound of my neck to make sure nothing is growing and repeatly being told I don't need one my TSH being very low was all I needed I finally got approved and did the Ultra Sound ....now I'm not sure If I should be worried about these results or not?  

I have had issues with stinging type of pains off and on in my throat and a swollen LEFT tonsil since my thyroidectomy that was always chalked up to me being a worry wart.  Below is actual US report.

RESULTS: Sonographic evaluation of soft tissues of neck and cervical lymph nodes:


A high-resolution high frequency linear transducer was used to insonate the bilateral cervical lymph node chains. Comparison was made with a thyroid ultrasound examination from 7/20/2016.

There are multiple bilateral cervical lymph nodes which are not enlarged by size criteria but several of them demonstrate no fatty hilum and/or hypoechogenicity and there is indeed a left level IV lymph node demonstrating coarse calcifications within its substance without enlargement or hypervascularity. There is no hypervascularity on color Doppler imaging in the remaining lymph nodes. All the lymph nodes demonstrate well-defined margins.

Recommend further evaluation with cross-sectional imaging of the neck either using contrast-enhanced computed tomography or gadolinium-based contrast agent enhanced magnetic resonance imaging or nuclear medicine imaging, as clinically deemed necessary.
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Hi Gracevd70,

I wanted to answer your question earlier, but I have no idea if that is something to worry about or not.  I just don't know enough about calcification in lymph nodes or what that might mean.  Did you have RAI treatment after your thyroidectomy?  I think getting the lymph nodes checked out, and especially if you are having neck pain and swollen tonsils is a good idea.

Do you have Hashimoto's?  I had two thyroid surgeries last year for multinodular goiter caused by chronic untreated Hashimoto's.  I had a suspicious nodule on the right lobe which ended up being papillary cancer (along with two other cancerous nodules out of the 8 total on the right lobe) and had the left lobe and isthmus removed in a second surgery after they found the cancer in the right lobe, but left side was not cancerous.  From my chronic Hashimoto's, my whole thyroid was very "inflamed", and my central neck compartment lymph nodes were swollen (1 cm sized lymph nodes).  I had 3 lymph nodes removed during the first surgery, and 11 removed total during the second surgery (3 stuck to the left lobe and 8 together in a giant lymph node clump).  Those were all thankfully benign, and after several months and multiple blood tests, we decided not to do RAI because there was no evidence of cancer spread outside the thyroid.  So abnormal or swollen lymph nodes doesn't necessarily mean cancer.

Doing a quick google, it looks like many infections can cause calcification of lymph nodes in addition to papillary thyroid cancer.  No hypervascularity and no enlargement are probably good indications, but I don't know enough about this.  I did see something that said calcification in lymph nodes can cause pain.

This is from a website, so I am not sure of the accuracy, but this is what I could find:

"If a calcified lymph node is found, this in itself isn’t an issue. When a lymph node is calcified, it is an indication of another problem in the body. It most likely indicates either an infection or possibly cancer in the area of the lymph node. Calcifications can also be caused by scar tissue from a previous injury or infection. In cases of cancer, the lymph node is usually removed for biopsy and to prevent the cancer from spreading.

Lymph nodes that are calcified are more like scar tissue from the resulting infection or cancer. The event that caused the calcification most likely happened years before and you most likely don’t even know it is there. A calcified lymph node is cause for further testing to see if the infection is ongoing, but treatment on the actual lymph node is usually not necessary.
In some instances lymph nodes that are calcified may cause pain. This can happen in the chest area if the lymph node pushes into a blood vessel that supplies the heart. In this case, doctors may opt to surgically remove the lymph node to relieve the pain."

Anyway, I think at this point getting it checked out and further testing is a good idea.  Especially if it is causing you stinging pain.  I'm not going to say "don't worry" because we can't tell at this point if it is benign or not, but I think you are doing what needs to be done already in getting the ultrasound and trying to figure out what is causing the pain.

Hi Sarah
Thanks for responding.  I did not have RAI or lymph node removal when I had my thyroidectomy for pap cancer.  I had ultrasound in 2016 that didn't show any odd or calcified lymph nodes which is what the Doctor compaired to this current ultrasound.  I been told repeatly that keeping my tsh low keeps cancer from returning, all a lie and to have doctor recommend pet scan or nuclear scan makes my mind wonder....I'm just tired of dealing with this nightmare.
Hmm that's very frustrating.  I'm sorry you have to deal with this.  It sounds like it is painful and needs to be further investigated regardless of whether it is benign or not.

I had so many lymph nodes removed because they were swollen and my whole central neck compartment was "inflamed" according to my ENT/surgeon... I think most doctors would only remove lymph nodes during the surgery if they looked suspicious.

Thoughts about your cancer returning:  
Does your doctor also monitor any thyroglobulin or thyroid antibodies?  This is one way of monitoring whether thyroid cancer is returning in people who have thyroidectomies.  My endocrinologist kept ordering some sort of thyroglobulin blood test for me.  I had to look up what exactly it is to explain it...  I have thyroglobulin antibodies as part of my Hashimoto's, so to test for presence of thyroglobulin (which would indicate I have thyroid cells present in my body somewhere), they look for thyroglobulin using Mass Spectrometry.  If you don't have thyroglobulin auto-antibodies, they can do an immunoassay to thyroglobulin, basically testing to see if the thyroid protein thyroglobulin is present or not or how much is there.  Both these tests just involve a routine blood draw, and avoid RAI uptake scans, and are less invasive.  Some people have some remaining thyroid tissue after thyroidectomy, so it's not a perfect science, but it is one way to monitor how much thyroid tissue is present and if cancer is returning.

If your doctor isn't monitoring your thyroid cancer that way already, this could be option to make sure it isn't returning, although I have to say I do not know all the specifics of the test, and I believe you need to establish a "baseline" early on and see if those numbers stay the same or go up or down.

We used this test to decide not to do RAI after my papillary thyroid cancer diagnosis - multiple nodes of papillary cancer usually means RAI, but mine were all about 1 cm each in size and encapsulated with no sign of spread outside the thyroid, so I was very lucky.  My ENT was convinced I would do RAI, so I was happy to have this test from my endocrinologist as alternative.

Best of luck -- I know other things can cause swollen tonsils and lymph nodes, but I definitely understand why you are worried about the cancer returning.

649848 tn?1534633700
Like Sarah, I'm not that well versed in calcified lymph nodes, however, calcification, typically, indicates that further investigation is warranted.  The fact that the margins are well defined and there's no hyper vascularity would be good signs.  

Although it's probably not cause for great concern, I'd recommend talking to your doctor to make arrangements for the recommended follow-up evaluation.
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