Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Thyroid and Ptyalism?
About This Forum:

Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Thyroid and Ptyalism?

I was found to be mildly hypothyroid (initial TSH around 6 or 7 I believe) last Spring. US in April revealed diffusely heterogeneous thyroid, and what the radiologist saw as two discernable nodules-one on the lower pole of the right lobe of 1.4CM and the other 8mm on the left lobe.
Internist started me on low dose (25mcg) levo and said to see an endocrinologist.

The endocrinologist did blood work and his own US. He upped it to 75mcg ( I am 5'3" tall and weigh 108 pounds) and changed it from generic to Levoxyl. He said I had Hashis and did more bloodwork. The thyroperoxidaseAb  came back 1238 (lab range normal was 0-32).

Within a few weeks of the dosage increase, I started to get (and still have) a symptom of excessive salivation, nearly drooling at times when I open my mouth to speak.  I also  have  constant numbness in my face, right side cheek area. This caused me to go back to internist who did a follow-up blood test and TSH was 0.169.

Returned to the endocrinologist who took exception to the Internist lowering my dose (internist had told me to alternate  50mcg one day and 75mcg the next) and the endocrinologist said to stay put at the 75mcg daily and come back in 8 weeks.
Went back last week and TSH was "less than 0.04".  He reduced the dose to 50 mcg .
As for ptyalism, the endocrinologist ( I don't think he'd ever heard this one)consulted his colleague and they concluded the excess salivation had nothing to do with the thyroid.
The only other time I had this symptom I was pregnant with my only child and also had hyperemesis. I am definitely not pregnant now (IUD), but suspect this is hormone related and read some older study abstracts online about hyperemesis and low TSH being related. Is it possible it's the levo ?  Could it be the  thyroid inflammation that is causing the ptyalism ? Meaning- could it just be that it's physically harder to swallow so I just feel that it's excessive?
Related Discussions
97953_tn?1193367871
This is a classic case of Hashimoto's Thyroiditis.  The excessive salivation is not typical, but could be part of too much thyroid hormone and the low TSH clearly indicates too much - so 50mcg seems like a reasonable dose.

Although the GI tests were fine, you symptoms are suggestive of reflux disease.  The thyroid could cause this and more time with appropriate TSH levels (in the low normal reference range) may help shrink it down and may diminish this sensation.  

Regarding the antibodies, selenium 200mcg/day is shown to help a bit.

Ultrasound -- done by the physician -- is the best way to follow the size of the thyroid and the possible nodules seen.  
2 Comments
Blank
97628_tn?1204465633
Rest of my long post, sorry...

A year ago I went to the Internist with a feeling of something stuck in my throat and went through a series of GI tests that turned out perfectly normal.
I still have the ever-present sensation, but it's a little more pronounced now, especially if I am flat on my back,  so I sleep propped up on pillows. My throat, on the right side, sometimes pulsates/spasms and I have simultaneously had facial spasms (lower jaw) as well.
I realize the "itis' in thyroiditis means inflammation, so I suppose this is normal?
Could the thyroid have grown much more since April?
Should I have follow-up imaging studies? What type?
Thank you for your response, it is much appreciated.

Blank
Continue discussion Blank
This Forum's Experts
97953_tn?1193367871
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
How to Silence Your Inner Critic an...
Apr 16 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eaters: How to Silence Yo...
Mar 26 by Roger Gould, M.D.Blank
1344197_tn?1392822771
Blank
Vaginal vs. Laparoscopic Hysterecto...
Feb 19 by J. Kyle Mathews, MD, DVMBlank