Hashimotos---Hoarse Voice 1yr

[Maman1]

I have had a hoarse voice for over a year now and have not been biopsed. I have a hot nodule on one side and right lobe non-functionning. I have Hashimoto's and am on 0.75 Synthroid. My Question is this: Should I not be having a biopsy or this nodule removed so that I may get my speaking voice back? I thot the only way they can exclude cancer is thru a biopsy. I am at my wits end. My Endo is re-sending me to an ENT Dr for evaluation. He seems to think I have a recurrent laryngeal nerve issue. I have already seen an ENT and they have excluded any vocal polyps or nodules. Should I not be having a surgery??? I am so angry at the host of Dr's that seem to consider my situation non-serious. I have also been diagnosed with BOOP Disease as well. Bronchieoltis Obliterans Organizing Pneumonia, which my respirologist says is not affecting my voice. I would appreciate any help and medical opinions.

[Mark Lupo, M.D.]

BOOP usually does not effect the voice and I don't think that the steroid (treatment for BOOP) causes hoarseness --- I would ask an ENT to look at the vocal cords to make sure they are moving properly - if there is nerve damage this can be seen as the vocal cords would be partially paralyzed.  

Hot nodules with hashimotos....interesting combo - I would biopsy the nodule and remove it if suspicious.  Nodules that are truly "hot" are rarely cancer - but my patients with hashi who have nodules usually undergo biopsy.

It is always difficult to establish if a nodule/goiter is causing hoarseness -- easier if it is a huge goiter -- sometimes having surgery is the only way to see if improvement can be achieved by addressing the thyroid issue.

[gudgels]

I just had a total thyroidectomy sept 28th. I had a HUGE multinodular goiter. I had no voice since begining of july- with hoarseness starting around March. I also had a "smokers cough and could not lie on my back , because I could not breath.
They did not think my hoarsness was due to the thyroid because I have nodules on my vocal cords. Right after the operation (in recovery room) I had my voice back almost completely!! Most people are hoarse after surgery... not me!. I finally have my voice back, cough is gone, I can breath better and lie on my back.
But of course there are now other problems... I am hypo- my tsh is 11. I don't know any other #'s since I am waiting for my blood tests. On .88mg of levoxyl.
Before surgery I had all symptoms of hypo/hashi's.(but blood test "normal" I tested negative, but the surgeon and pathologist said it looked and felt like a hashimoto's thyroid. (get that!)
Before surgery my tsh was .44
T4 Free 1.1
T4,total 8.2
T3 uptake 28.8
T4,Free, Calculated 2.36
T3, Total- 190 -which is High
T3,Free 352

I was feeling great after surgery and now almost 2 weeks post-op I have kind of crashed. (probably doing too many loads of laundry). I am exhausted all the time. any advice? Endo says next blood test are not for a month, and then will see about upping the meds. thanks
Anne

[doodlebug1]

Hi gudgels. Glad to read how well you recovered your voice! Good for you! I do want to make the following comment: you are on a T4-only med. I, too, was on Levoyxl once, for years and years. And the entire time, I never ever rid myself of hypo symptoms. It's only when I switched to Natural Thyroid hormones, also called Armour or other brands, did I get total relief. I think it's because natural dessicated thyroid gives you exactly what your own thyroid would be giving you--T4, T3, T2, T1 and calcitonin. It TOTALLY changed my life around.  I also was allowed to dose by SYMPTOMS, not the TSH. I used labs to observe my free T3, which I worked to get at the top of the range. I also dosed by temps--working to achieve a before-rising temp of 97.8 - 98.2 and a mid-afternoon temp of 98.6 (all using a mercury thermometer). I am now on 3 1/2 grains, with a great temp, not one hypo symptom.  And it has been a godsend for me, and has apparently for most everyone who has switched to it, by what I have observed, and who have been allowed to dose by symptoms---the way it was done before T4-only meds and the TSH ever came onto the scene. Maybe this would be worth your investigation?

[gudgels]

doodlebugs,
Thank you , I have researched this, and I think you are right. I know that this isn't for everyone , but I do have a strong feeling it will be the way for me. I have NEVER been normal..ie..blood test vs. symptoms. The surgeon swears I had a Hashimoto's thyroid-( and I had symptoms, but tested neg.) I just started .88 levoxyl and I am going to give it a chance. I have said I would give it to the 1st of Jan. I don't want to jump and I know it takes a while to regulate the meds.
I do know I will need to find a new Endo, because I metioned it to mine already and he Dismissed me. (no surprise)All he seems concerned with is my weight gain ( which of course he doesn't seem to associate with my thyroid at all!!!!)
Thanks for the advice, and I really am learning that you have to become your own advocate and stand up for yourself.
Anne

[doodlebug1]

Yup. You hit the nail on the head. We gotta be our own best advocates!! Hang in there! Armour works--you'll love it....when that day comes. :o)