A 33-year old female with general malaise and fatigue underwent an ultrasound of the neck. The radiologist reported a finding, which I have reproduced in this anatomical sketch- (the area of concern is highlighted with the arrow). She is a secretary and just got married. For the past few months, she has developed fatigue and does not feel like doing anything. She is on no medications, has no allergies and has not lost any weight. She has been to several healthcare professionals and no firm diagnosis was made. The physical exam is non-contributory. After viewing this anatomical sketch, what is the next step in her investigation?
A. Order Calcitonin and calcium levels
B. Examination of her oral cavity
C. Antiperoxidase and antimicrosomal antibody titer
D. Fine needle aspiration
E. Mammogram
F. TSH levels
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The Delphian node also known as a prelaryngeal/precricoid node, is one of the cervical lymph node groups that comprises level VI cervical lymph nodes
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The delphian node is located above the thyroid isthmus and is usually not easily palpable
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The delphian node receives lymphatics from the upper segment of the thyroid gland and the larynx
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When it is enlarged, one has to suspect metastatic disease from the head and neck area, especially the thyroid
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The first test of choice is to order Calcitonin and calcium levels to rule out Medullary thyroid cancer and parathyroid adenoma, respectively. If these prove negative, the larynx needs to be examined
