CT scan of Neck/Enlarged lymph nodes

[AprilE1]

Slightly prominent lymph nodes bilaterally in the neck, most prominently in the submandibular chain, with the largest on the right measuring approximately 1.7 x 0.9 x 0.8 cm located between the right submandibular gland and the right jugular vein at C3 level and the largest on the left measuring approximately 1.4 x 0.8 x 0.8 cm, likely benign reactive, although clinical correlation is recommended to exclude low-grade leukemia, lymphoma, or other lymphoproliferative disorder, with metastatic adenopathy less likely. Tiny nodular densities just below the inferior tips of the right and left lobes of the thyroid on axial images 60-62 likely represents small lymph nodes rather than bilateral parathyroid adenomas. The thyroid gland appears unremarkable. Bilateral submandibular glands and parotid glands are unremarkable.

For some back story: I have hashimoto's, my wbc on labs was 3.34, I've not recently been virally sick, but I constantly feel very fatigued, weak, and deal with a tremendous amount of brain fog. I do occasionally get some pain in the right side of my neck, just under the jaw bone.
What should I expect from this? Monitoring? Biopsy of enlarged lymph node? Is this normal and I'm making myself worry over nothing? any insight or encouragement would be appreciated.

[Ken_PA]

Oh, and try not to press on them too much :) That can inflame them and make them tender.

[Ken_PA]

Hi, I don't think there's much reason at all to fear a cancer. rather, it looks very much like an immune system reaction all around - including the tiredness and brain fog. For instance, interferon is a naturally produced biochemical used to fight viruses. It's also synthetically produced to use as a drug against hepatitis C. Patients who take that often report heavy brain fog. Other immune chemicals can have the same effect.

Having Hashimoto's tends to mean you'd generally have other hyperactive immune effects, such as enlarged nodes.

The shape of your enlarged nodes is good, being more oval than rounded. They are not too large anyway. Did you have contrast with the CT? If so, then the CT can see the 'internal architecture' inside a node which is a good way to know that it looks benign and not-cancer. There were apparently also not any flecks of calcification, which is why the report says that metastasis is not likely (spreading from the thyroid or elsewhere).

If you ever do have a followup scan, I'd ask for ultrasound rather than CT, btw.

There's not enough justification for a biopsy. No doc would be alarmed over this. But I'd think the more you learn about the immune system, the more you can relax. Also be aware that it's not unusual for nodes to get filled with scar tissue (fibrosis) and they do not go down in size. So staying enlarged does *not* mean it's cancer.