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Suggest Treatment For Swollen Lymph Node On Neck While Treating Polymyalgia Rheumatica
Question: I am a 53 yo female with a diagnosis of polymyalgia rheumatic since October 2014. Previous CRP level of 24. Latest CRP normal after a couple of rounds of low dose prednisone. I have an enlarged lymph node of the left side of my neck for the past week associated with painful swallowing and pain when yawning. CBC and Chem 12 were normal. No relief with OTC medications such as Acetaminophen and Aleve. Family history of Thyroid cancer in younger sibling. No sudden weight loss or excessive night sweating. Was seen by an urgent care PA who prescribed Tylenol and Aleve. I am an RN so of course I jump to Lymphoma or cancer. How long should I wait to seek treatment. Pain upon swallowing is becoming much worse over the past 5 days. No fever.
Brief Answer:
Likely to be benign, workup needed if persists beyond 3 weeks
Detailed Answer:
Hello and Welcome
I appreciate your concern
A recent ( one week as per your query ) enlargement of a lymph node is most likely to be benign. Even though the history of thyroid malignancy is alarming, instead of primarily going for expensive workup, a physical exam alone could determine whether any further workup is required or not. The cervical nodes should be examined to feel for diffuse lymphadenopathy or if its a single enlarged node. The Thyroid should also be examined and if the need be, an ultrasound of the thyroid can be advised. The pharynx and tonsils need to be visualized to look for an infection focus. If an infection is suspected , antibiotics can be started empirically after taking culture samples. Ibuprofen and acetaminophen can be used for the pain with swallowing. At least three weeks should be given for the node/nodes for observation. Within this period, If the node returns to its normal size then you can relax. Upon follow up after 3 to 4 weeks , if the node is still enlarged then an excisional lymph node biopsy should be planned, in consult with your doctor, to determine a tissue diagnosis.
Let me know if you have any query
Wishing you best of health
Thanks
Dr. M.S. Khalil
Likely to be benign, workup needed if persists beyond 3 weeks
Detailed Answer:
Hello and Welcome
I appreciate your concern
A recent ( one week as per your query ) enlargement of a lymph node is most likely to be benign. Even though the history of thyroid malignancy is alarming, instead of primarily going for expensive workup, a physical exam alone could determine whether any further workup is required or not. The cervical nodes should be examined to feel for diffuse lymphadenopathy or if its a single enlarged node. The Thyroid should also be examined and if the need be, an ultrasound of the thyroid can be advised. The pharynx and tonsils need to be visualized to look for an infection focus. If an infection is suspected , antibiotics can be started empirically after taking culture samples. Ibuprofen and acetaminophen can be used for the pain with swallowing. At least three weeks should be given for the node/nodes for observation. Within this period, If the node returns to its normal size then you can relax. Upon follow up after 3 to 4 weeks , if the node is still enlarged then an excisional lymph node biopsy should be planned, in consult with your doctor, to determine a tissue diagnosis.
Let me know if you have any query
Wishing you best of health
Thanks
Dr. M.S. Khalil
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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