thyroid nodule, fatigue and throat problems?

[suze.quze]

Hello~35 yo F, healthy. Fatigue began mid Feb, annual 3/23, PA said big thryoid, did US 4/9. Before US, fatigue worsened & throat got bad: swallowing, weird hoarse voice, and some neck pain. US id'd one nodule, 1.7cmX 0.9cm. 4/19-RAI ='slightly cold', radiologist sd hard to biopsy b/c location.
1st appt endo: did sonogram, 'nodule complex & receiving bloodflow'. I noted bad fatigue, frequent hoarseness and swallowing problem (allergy pills sit in my throat after taking them with multi glasses of water, only food pushes them far enough so they go down). 2nd appt endo: US guided FNA on 4/30. On 5/7, left neck lymph nodes (same side-nodule) swelled. Got to see endo PA 5/8, fluid behind ears and est. sinus infection, so Rx'd azithromycin + benign!. I'm prone to SI ~avg 1-2x yr, do NOT get lymph node swelling except with bronchitis,  strep (maybe 3x in 15 yrs). Next day left jaw swelled up-(neck lymph nodes went down some) so saw PCP late 5/9.  She didn't think I had SI/ we talked maybe antibiot allergy/ but on my 4th time on Zpak so unlikely.  5/18: badly fatigued, still w/ swallowing problem, PCP did blood & sent chest xray + barium swallow: xrays=ALL normal, T4 normal, and TSH is 1.4 (late March was 1.8) so norm thyroid function.  
Fatigue JUST broke 5/26-feel like old self EXCEPT swallow issue, left jaw swell (~ 3 weeks now) and minor jaw/ear pain.  New:Left face tingling/numb ~5/25:fr ear/jaw to nostril,up near eye. Voice problem improvd last 2 wks. Help/thx!

[Mark Lupo, M.D.]

FNA result was benign, I presume.

I have seen some similiar numbness/tingling after FNA -- even 3-4 weeks after -- this usually resolves w/i 6 weeks max.  This is not common, but it happens.

Check antibodies to see if you have hashimoto's - can see reactive LNs in these cases.

Consider thyroxine treatment if positive antibodies.

[suze.quze]

FNA was benign, yes.  I will ask for antibody test re: hashi - thank you.

Face tingling seems to be fading - prominent for only a few days.

Also, Q re: swallowing problem/other throat/neck issues.  Primary was going to refer me to a GI specialist for swallowing problem, but friends suggested an ENT with the other neck issues I have (left jaw swelling, jaw/ear pain).  Would an ENT help identify if there is something structurally problematic w/ the nodule?  OR, if Hashimoto's is the case, would getting treated for the antibody issue potentially clear up some of my other issues-swallowing, ear/jaw pain?  I ask because now that the fatigue has cleared (and brain fog gone, now that mental clarity returned), pain has become more noticable (ear/jaw) and now also notice it in the left side (towards back of) my neck.  

[christine m]

Does your endo think that the nodule is encroaching on the thyroid capsule? I have a multinodular thyroid and the pain from the nodules pushing on the capsule is maddening. It radiates up neck, into ears, back of the neck, causes terrible headaches. I also had multiple episodes of nodes that my endo called reactive nodes. This is a node that swells in response to the thyroid inflammation. I know how badly you hurt. What absolutely saved my life was a taper of Prednisone. It took the pain away immediately. Of course, as soon as the taper stopped it returned, but it did help for the time being and allowed me to sleep.You can also have what is called thyroiditis without positive Hashimotos antibodies, there are three types and not all antibody positive.You can have what is called subacute thyroiditis which is due to virus, immunizations, stress, or pregnancy. This is an antibody negative situation but usually has abnormal TFTs associated with the complex. Why not try a short burst of Prenisone, it's not a scarey drug short term and if it works, believe me, you'll be overjoyed.

[dmastrolio]

A related discussion, Throat clearing and congestion was started.