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Thyroid (Expert Forum)
Thyroid pain and nodules
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
Thyroid pain and nodules
by Texasjenn, Apr 10, 2006 12:00AM
I've been having pain in the front of my neck for nearly 9 mos. MRI was done in Nov '05 on my neck. Showed some slightly swollen lymph nodes (1.4 x 0.7 & 1.3 x 0.7) and a "1.2 x 1.2 cm enhancing mass in the mid zone of the left thyroid lobe probably a thyroid adenoma". An US was performed on the neck in Nov. '05. The US showed 2 masses: 14.1 x 8 x 7.3 mm and 21.6 x 11 x 10.5 mm. A biopsy was done by my ENT dr. When he first started the procedure and he saw the masses on US he said he could tell by looking at them that a biopsy was not needed. I asked him to do it anyway. He had trouble doing the biopsy because the fluid was so thick(?). He did 8 slides and the findings were "shows no thyroid epithelium, blood and some thin colloid-like material is present, the specimen is nondiagnostic". Upper GI and scope ruled out acid reflux. Blood work ruled out infections, etc. All thyoid blood tests were normal. Ruled out thyroiditis. But the pain continues. Had second US at the end of Feb. '06. Masses now measure 15.8 x 9.6 x 9.3 mm and 22.6 x 11.8 x 9.1 mm. ENT dr. put me on Synthroid and surgeon said I should have thyroid removed to alleviate the pain. I went to Endo dr. She said she doesn't think pain is normal for size of cysts. She ran blood tests and now after 1 mo on Synthroid I am borderline hyper. Stopped meds. She wants to repeat US in 3 months. Had a second MRI on neck that shows bulging disc in cervical spine. (?) My pain continues quite bad at times. Pain originates at l thyroid and goes to ears and jaw. DOES ANYONE ELSE OUT THERE HAVE PAIN?
Doctor's Answer
by Mark Lupo, M.D., Apr 11, 2006 12:00AM
, Apr 11, 2006 12:00AM
You need a repeat biopsy (fine needle aspiration). This should be done under ultrasound guidance. Most cysts are benign & I agree that the size of the cysts are unlikely to cause pain. Would test thyroid antibodies. There are situations of painful variant Hashimotos - usually these get better with time (may take a year or so). The synthroid does not often help the pain, keeping the TSH 0.5-1.5 is reasonable however (ie not necessary to make you hyperthyroid).
The "thick fluid" on aspiration is likely old blood in the cyst -- this is common and also it is not uncommon to get a nonsatisfactory result with cysts.
The bulging of the cervical spine is unlkely thyroid related and may be another possible cause of the pain.
Would try to avoid thyroidectomy unless this is a last resort effort to control pain OR the cysts have suspicious cells OR the cysts continue to grow significantly.
The "thick fluid" on aspiration is likely old blood in the cyst -- this is common and also it is not uncommon to get a nonsatisfactory result with cysts.
The bulging of the cervical spine is unlkely thyroid related and may be another possible cause of the pain.
Would try to avoid thyroidectomy unless this is a last resort effort to control pain OR the cysts have suspicious cells OR the cysts continue to grow significantly.
I have had severe endometriosis since 1989 for which I have had five surgeries with a complete hysterectomy as the final step. Have had some problems since but none within the last 9 -12 mos. Did have some problems with hormones? Was off of estrogen for 14 mos. Just trying to start it again. (Bio-identical with progesterone) Never had any thyroid problems throughout endometriosis.
Also, before I started having the throat/thyroid pain, had several events:
June '05 strept throat (2 antibiotic treatments)
July '05 car accident
July '05 hives (treated with medicine)
Don't know if any of this has to do with anything.
Funny you ask about the accident and whiplash. I did not think I had whiplash although I was quite sore and had a lot of trauma from the airbag. My endo dr. actually was the one who ordered the neck MRI which showed the bulging disc. It is just very hard to imagine that the pain that originates in the left/front of my neck would be from that. Everytime I point to the pain origination spot the drs. say, "Hmmm. Looks like your thyroid". But then all the drs say that I should not have pain in my thyroid. I also have discomfort when I swallow sometimes. And every so often I feel like there is this big knot in my throat. I have trouble sleeping at night because the pain