Thyroid discomfort

[Bove]

I am 48 years old.I was diagnosed 18 months ago with Hashimoto's Thyroiditis.  I had an inflammed and enlarged thryoid. It was uncomfortable, almost tender and the discomfort extended down to my clavicles and around to the back of my neck.  It was difficult to put my chin down.  I had normal TSH and Thryoid panel with elevated antibodies.  An ultrasound showed an enlarged thyroid. I started on levoxyl with almost immediately relief from the discomfort and symptoms but periodically it feels mildly inflamed, usually before and during my period.  The fatigue and depression, that still occurs, how do I distinguish from perimenopausal and PMS symptoms?  Are there other tests I need to get.  I have been maintained on 75mcg of Levoxyl.
I mentioned the recurrent thryoid discomfort to my endocrinologist, who said one has nothing to do with the other.  I saw an ENT and has my sinuses and throat scope'd.  He said also one has nothing to do with the other but did mention that approx 30% of his female patients with thyroid problems have mentioned this symptom.  Am I crazy, missing somehing?

[Mark Lupo, M.D.]

There can be painful-variant Hashimotos.  Usually gets better with levoxyl-type treatment -- best to keep the TSH around 0.5.  If the pain is really from the thyroid, there is not a lot to do besides a trial of steroids (not recommended for more than brief treatment time) or surgery.  Over time, things usually improve with thyroid med alone.  There is limited data on using I-131 in hashimotos to try to shrink the goiter.