Lymph node evaluation in patient with history of papillary thyroid cancer by Dr Sean Nikravan, MD

This video is an illustration Evaluation metastatic thyroid papillary carcinoma in a patient who has a lymph node measurement 0.38 cm. This video illustrates the identification of the lymph node during the initial examination, in clinic ultrasound guided interpretation and biopsy. The treatment options in a similar case is typically either reexploration neck dissection removal lymph node versus how much newer technique which is thyroid radio frequency ablation minimally invasive in office procedure with no downtime!
Taking this patient back to surgery will successfully increase risk as this will be the second time the patient will undergo neck surgery. Recurrent neck surgeries increased morbidity associated The existing develop scar tissue.. each case should be evaluated carefully and discussed regarding treatment options.
Sean Nikravan, MD, FACE
Endocrinology & Metabolism
www.seannikravanmd.com
[e-mail]
949-650-0616

[@deidrehaye7061]

Hello! I recently had a thyroid ultrasound done with no suspected nodules, but they found a 7mm x 4 x5 lymph node on the left side of my thyroid...would you recommend that being biopsied? I have Hashimotos and they arent able to distinguish any nodules from my thyroid tissue.

[@Pezhman101]

I would recommend you follow with a repeat ultrasound in about 3 to 4 months. Lymph nodes are not uncommon specially after infections or a viral illness. Lymph nodes are more suspicious, especially if there’s a history of thyroid cancer, which you do not have according to your description. Therefore follow-up repeat ultrasound in a few months would be recommended unless the ultrasound characteristics of the lymph node are suspicious, which I cannot tell based on the size.

[@michelebailey2780]

Hi. What does level 3 mean on the ultrasound scan?

[@jillr759]

The level of tissue the node is at to reference its location for future surgery or exams.

[@Pezhman101]

It is anatomical geography of where the lymph node is located in the neck

[@MrsBear31]

These patients node was 4mm? And on FNA was going to have metastasised?
I had a partial thyroidectomy, right lobe for papillary carcinoma.
Pathology came back supporting this and also noted “suspicious for vascular invasion”
My left and right lymph nodes were recently noted in a follow up U/S as large, nonspecific with measurements of 2.3x1.5 cm by 8mm and 3.0x 2.0cm by 9mm
Also a T-RAD IV nodule that was previously noted on my left thyroid nodule as 3 x3 mm a year ago was 4x4m in October (at time of surgery) and now it’s 5x5mm on the new U/S
Would you suggest I would benefit to have
Another FNA on one or both lymph nodes?

[@jillr759]

I had my right jugular removed and massive amount of muscle and positive nodes. I’m RAI resistent. Did you get the biopsy.

[@Pezhman101]

For case like this, you would need confirmation that the lift note is metastatic because sometimes lymph nodes can be inflammatory secondary to cancer. Therefore, please confirm that the lymph node is metastatic if the lymph node is metastatic and not attached to a vital neck structure, then radio frequency would be a good choice. After multiple lymph nodes in the neck surgery may become a better option specially if bilateral lymph nodes.