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Thyroid pain and nodules
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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.

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Thyroid pain and nodules

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?
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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.
14 Comments
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Avatar_n_tn
Also, forgot to mention that have been having some discomfort under arms and in groin area.  This started within the last few weeks.
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Avatar_n_tn
I have been reading more and more posts and I wish there was something helpful I could add.  But did realize from other posts that I should add a few more things to mine . . .

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.
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Avatar_n_tn
Is Hashimoto's the same as thyroiditis???  They did a blood test to verify that I do not have thyroiditis and have ruled that out.
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Avatar_n_tn
I'm not sure which blood test it was -- just that doctors said thyroiditis was not my problem.  I'll get more educated on it.

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 in the front of my throat is so bad.  

I actually have an appt with my neurologist tomorrow to review the MRI and all the problems that I have been having. We'll see what he says.  

I appreciate your thoughts.  Let me know if you think of anything else that might help.
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Avatar_n_tn
Well, neurologist says that bulging disc is so minor that he actually had a hard time seeing it on the pics and said there is no way it could be causing any pain.  He said he thinks it is my thyroid.  

Endo dr. discussed results with me and said she doesn't know anything else to do at this point.  She said we can redo biopsy if I want but it will probably come back inconclusive again because there is a high probability of the same result once you've had an inconclusive before.  Her recommendation is to take out the left lobe.  She said it may turn out to be some sort of Hashimotos even though my bloodwork doesn't concur.  I'm not excited about doing that but the pain is so bad and I just want some relief.

Thanks for your continued input.  It is nice to know there are other people out there to talk to.  By the way, you mentioned whiplash causing thyroid problems.  Is there a reference book or website out there that discusses this.  I've brought this up with my doctor but would like something to use as reference.  Thanks!
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Avatar_n_tn
I, too have had neck pain for almost a year now.  I have been diagnosed with multi-nodular goiter.  I have had 4 biopsies already, all benign.  However I get shooting pains up the front of my neck, sometimes one side, sometime the other.  The doctor agrees that although the nodules are showing benign, thyroid removal is certainly an option because of the pain.  I want to feel certain that the pain is caused by the thyroid before having it removed.  My neck is swollen some but it isn't anything that anyone would particularly notice.  Does anyone else have pain associated with this?  And have you had your thyroid removed and has that helped?  Thanks.
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Avatar_n_tn
Hi,

I've had problems with my neck and thyroid the last 18 months.  It all started after a cold/sinus infection.  The muscles on the sides of my neck hurt and my heart felt strained.  Went to the dr.  They ordered a contrast CT of the neck.  Showed I had a multinodular goiter.  Only the goiter was nearly double the size and you could see it.   Blood work first showed TSH normal at .77.   I then had pain and my heart pounded hard.   I went back to drs. several more times.  They did more blood work.  All "normal" but my TSH dropped to .51.  They sent me to have an iodine uptake and it came back that I was hyperthyroid.  Told me to see an Endocrinology.  Saw him 5 months after the onset and he retested my tsh and it was "normal" again at .55.   I had been in severe pain and radiated across my upper back and chest and even my arms.   But by month 5 I was feeling a lot better.  Endo suspected "subacute thyroiditis" even though my ESR was normal.  He sent me to a surgeon who recommended removing the right lobe.   I sought a second and third opinion but my the time I saw all these dr I was feeling well enough to wait.  

Round 2.  Although I felt better for a while I never felt "good" again.  Then a virus/ cold hit my family.  Next thing I knew I was in pain again and all the previous symptoms were back.   I begged one Endo to see me but had seen a surgeon first.  He was ready to take the whole thing out but sent me to this Endo first.  She didn't think it was my thyroid!!  It made me question how much she knew even though she had been recommended.  But my condition was too rare for her.

I had another CT Scan that showed no change.  And an MRI showing the multinodular goiter.  That's the only thing that was consistant on the findings.
Yet my endo told me  I was hyper one month and another month later I was normal.
I couldn't endure the pain.  I wanted my thyroid out but they were hestitant.   I went to a ENT surgeon but by time I saw him I started to feel better again so I decided to wait.  It had been 3 months from the onset.

I gradually felt better from that point on but still felt the pressure an occasional "choking" in the throat.  There's a pull in the back of my throat.  And during acute inflammation I feel and hear squishing sounds if I move my head up and down.

I kept hoping that if it was Subacute Thyroiditis it would just gradually go away.
But then I got another cold just a month ago and it came back.   This time I knew what to do right away--- use ice packs and take Advil.  Had another ultrasound which still shows the multinodular goiter (which I now think is really the thyroid inflammed.).   A few months ago my TSH was .89 when I was feeling good.  Last one was .66.   My doctor said it was all the same.  I disagreed and asked to be sent to my ENT.  

I made an appointment was ready to have the thyroid removed.  Got a call from my surgeon's office that he decided to take the summer off and may retire!!!!!   I was so bummed.  That alone put me in depression.

This pain and discomfort is not normal and doctors need to wake up.   I'm tired of being told it's only ANXIETY AND DEPRESSION.   They are the ones DEPRESSING me.

Anyway,  Thyroiditis is nasty and very hard to detect.  ESR is not always elevated and TSH can be in the normal range but you will definitely see a drop when it is inflammed.

Hope that might shed some light.




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Avatar_n_tn
i have 2 questions.i am a 28 yr old female. i was feeling weak and muscle twitches were a problem, including depression, panic attacks and irregular heart beats . so, i went to the dr's and they took a blood test and told me that my thyroid was a little out  of wack..so, they gave me a bloodtest each month to see if the numbers were getting any lower. well, the lowest it got was .21, so, she said "no" to medication. and the last time i went for the bloodwork, she said my thyroid was back to normal. i am having every symptom of a hyperthyroid person and how, all of the sudden, did my thyroid get back to normal w/o any meds???        should i go to another dr. for this problem, for a second opionion? if i do,she won't see me again, which i have no problem with.
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Avatar_f_tn
Giving you meds for a TSH of 0.21 will only make your levels go even lower to the hyper side and  worsening your symptoms plus perhaps adding a few more which could be the dangerous ones. Or treatment with ATDs  without  Lab back up (full thyroid panel that relates you having a thyroid issue).

Many other health conditions share thyroid symptoms so don't rule them out, it could be dangerous to your health.  For one MVP - Mitro Valve Prolapse.

It is not unusual for hypers to go hypo before going  full hyper and the same for hypos going hyper before full hypo. No doubt that is the reason for your doctor checking once a month, although I think every 3 months for a year would be appropriate, then every 6 months for a year, then once a year thereafter, and that is of course your level stay within Lab range..  You need to stay on top of this incase your thyroid goes full blown in which ever directing.  Plus, there are many reasons why  levels will fluctuate, it really not that unusual for a lot of us.

If it will set your mind at ease go for a second opinion.  Have TSH, FT-4, FT-3 and both antibodies for Hashi and Graves' done.  Get copies with the Lab range for future reference.  Don't be disappointed though, if your levels are in Lab range.  A good doctor will not treat by symptoms or antibodies alone or if your levels are normal.  There must be levels to back up the rest.  If not then keep abreast of them and mean while look in other health directions.

Good Luck.

~~~~~~~~~~~~~~~~~~

I am not a Doctor or in the Medical field.
My statements and comments are meant as
information guide only, not as a diagnose or treatment,
for that is between you and your doctor.
I have Graves' Disease treated with RAI and TED
with possible Hashi.


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Avatar_n_tn
now i have a question about the MVP disease you mentioned. now, i am going to a cardioligist next month to see if i have an irregular heart beat(my heart flutters alot, pounds real hard and i about pass out when this happens). does the cardiologist deal with MVP? can they diagnose me with that disease? if not, then, who would i have to go see about MVP? i feel as if i am a hypochondriac, but i am not feeling like my old self, so, i know something is wrong with me, and the only way i can find out is, if, i go see a dr. ----     do dr.'s care if you keep making appts. for different things, all the time? i just feel sooo stupid going to the dr's office all the time. thank you in advance for all the help.=)
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Avatar_f_tn
Hey! don't feel stupid or like a hypochondriac , you are the one paying for it, plus you know your body better than anyone . So if you don't feel good, you don't feel good, and you are a smart women looking in different health avenues for the cause.

Definitely MVP is in the field of an cardiologist, for it has to do with the heat valve.  Mention it to the doctor.
An echo-cardiogram is how MVP is detected for sure. A lot of people with thyroid have MVP, so some believe that they could be connected in some way.

Good Luck.

~~~~~~~~~~~~~~~~~~

I am not a Doctor or in the Medical field.
My statements and comments are meant as
information guide only, not as a diagnose or treatment,
for that is between you and your doctor.
I have Graves' Disease with TED,with possible Hashi,
treated with RAI  
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Avatar_n_tn
I have neck pain and was recently diagnosed as hypothyroid.  There is very little swelling in my neck, but I am having trouble swallowing.  Also, it feels as though I always have soimething in my throat, and my throat feels raw. My SCM muscles ache and I feel pressure in my neck.  I have been on synthroid (125mcg) for two months and although I feel moderately better the pain in my neck is getting to be unbearable. Any advice as far as treatment etc.

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Avatar_f_tn
Before any tereatment you need to know what is causing the pain.
So you need to discuss this with your doctor. You might need some test done to rule out health conditions.  If it is thyroid related they probably will do something like a thyroid scan of your thyroid. But only your doctor can have all this done.
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Avatar_n_tn
A related discussion, throat pain was started.
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