Pain in this area may be caused by swollen lymph nodes, or it may be caused by thyroid problems such as thyroiditis, thyroid adenoma or thyroid nodules, or even thyroid cancer. To make a definite diagnosis, it is recommended to have a local ultrasound to determine whether there is a mass or enlarged lymph nodes, and to have a functional test of the thyroid gland, usually a blood test to identify thyroiditis, hypothyroidism or hyperthyroidism. If there is a high suspicion of thyroid cancer, a local puncture biopsy must be done to confirm the diagnosis.