I am not clear on whether your ultrasound detected hypoechoic nodules within your thyroid gland or if you are referring, instead, to cervical lymph nodes. If the US revealed two ill-defined thyroid nodules, then they should be sampled with a needle biopsy (FNA) to assess for possible thyroid cancer. If you have only mildly enlarged lymph nodes, but no thyroid nodules, then one has to determine if these lymph nodes are enlarged because of infection or inflammation, or are they enlarged due to a malignancy (either lymphoma or cancer that has spread from another place)? When lymph nodes suddenly become enlarged and painful, most of the time this is due to an infection (although, of course, there are always exceptions to any rule).
Because I don't have enough information to give you very specific advice (and one cannot make specific diagnoses over the Internet, anyway), I would suggest that you obtain a consultation with a qualified ENT surgeon for further evaluation of these findings. (You should, of course, also quit smoking.)
Sincerely,
Robert A. Wascher, MD, FACS
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