After reading a few threads, this is something I've been suffering with since Oct 2001 and no doctor has been able to give me an answer. This is the cliff notes version.
I've seen THREE endocrinologists (going on 4), an Immunologist, ENT (who pointed towards the thyroid more than once), Allergist, a dentist specializing in TMJ and even a chiropractor which felt like it was irritating my neck with adjustments.
It started with a choking feeling in my neck. I came home from work ripping off my turtle neck and having dry choking heaves. After that I couldn't wear anything around my neck including necklaces, turtlenecks, or my hair touching it.
About two months later, I was diagnosed with mono and was in bed from Jan 2002 to March 2002. During this time I gained 50lbs in those months going from 140 to 190lbs.
I saw an endocrinologist in April in Rochester NY who said I had "Fibromyalgia of the thyroid" and that there was nothing wrong with me.
I went to another endo. in Buffalo NY. She looked at my blood work and said "There is nothing wrong with you."
I said: Why do I have this feeling in my neck?
She said: Don't know.
-- and sent me on my way
I had an ultrasound in 2002 that showed some nodules on the thyroid. No doctor addressed it.
I continued to have this feeling in my neck. My shirts are all pulled out, I wear V necks, I put my hair up, I can't wear necklaces and I also cannot touch the front of my neck. It's hard to find a comfortable spot when sleeping because pressure below my jaw radiates. I can't wear a scarf or a winter coat with a high collar because it rubs on the sides of my neck.
I began to live with this as annoying as it was.
Last year, I went to another endocrinologist regarding some other problem and stressed that I had this issue since Oct 2001. She did another thyroid test and found my leves were off. Gave me synthroid.
She did an ultrasound and took a biopsy of the nodules. No cancer. Thyroid was a little enlarged.
I was told to live with the feeling in my neck.
I CAN'T DO THIS ANYMORE!!!! Right now the neck is too tight, I have keep taking Advil which is not good to relieve this tightness. I feel like no doctor cares to help and that I'm the only person in the area with this problem.
It all started around the time I was experiencing symptoms of mono before I was diagnosed.
I see another endo in November. What else can I ask for to see if this problem can be solved (aside from having the thyroid removed). I'm at my wit's end!
This symptom is common in post thyroidic removals, but not that usual when your gland is only "slightly enlarged." See posts on this at: http://www.************.com/Tightness__fullness__painful_neck_post_Thyroidectomy_t79020.html
In your health history discussions with your Endo, did you mention your history of Mono and the weight gain? Is it possible this was a misdiagnosis? I would suggest you discuss your medical history very thoroughly with the new Doc.
With my throiditis, I have redness across my chest, just as if I had worn a wide open collar shirt and gotten a sunburn from it. It is slightly sensitive at times, but nowhere near your symptoms. This is fairly common I've learned, but your level of pain and discomfort should be addressed faster than 1 month. Consider a detailed physical with a GP sooner, and address the health history and current issue at length with them first.
I have the choking feeling too, and the strange redness around my throat in the thyroid area. I have found that when I first wake up it's not there, but after a few minutes of drinking something (AM coffee), it starts again. So, I'm thinking mine (thyroid gland) is becoming irritated and swollen from the swallowing. It could be caused by stress, or angina of the throat. My mother had angina of the throat and chest after my brother died. I think she was prescribed Valium at the time. If you have a nodule that is large it can cause this (like mine), or a goiter. I would ask/demand if you have to that another ultrasound be done on your neck..if you can't find a good/willing endocrinologist, then maybe a good ear, nose, and throat specialist can help find the problem. My thyroid issues were discovered by my GYN, but I was only going to her and no one else at the time.
Thanks so much! I am going to keep pursuing this with a decent endo. I went to a neurologist and he said this was not neurological because the feeling wasn't just on one side which would indicate the brain is controlling this.
The sad thing is, I have valium for panic attacks however when taking it, the feeling never goes away.
Would an MRI show anything? With all my complaints no one has issued an MRI of the area.
I have Hashis and have had a tight feeling in my throat for a while. I had a positive blood test for gluten sensitivity so my GI doc did an upper endoscopy. I did not come back celiac, but he said I do have acid reflux. Well it was pretty mild, so I ignored it. Six months later I saw a new ENT and told him about my throat. He asked me about acid reflux and I said that I get a little bit of heartburn. He put me on Protonix, for acid reflux, and my throat is not tight anymore. Just my story, maybe you should check it out.
I have experienced this choking, gagging feeling for a while now with large goiter. Have you had a recent thyroid ultrasound? If not it may have increased in size. I also have complained of a strange red "flushing" on my neck above the thyroid for about a year and a half. My family doc just shrugged it off. Don't be discouraged, it is so aggravating when you know something is wrong and doctors don't take seriously. I agree that it would not hurt to make sure your heart is okay. Angina can cause neck tightness although that would be a long time to have that. Definately need current ultrasound as mine almost doubled in size over 3 years. Your neck symptoms sound just like mine, nothing but v necks for years. Hope this helps.
I used to and still do get the feeling you are talking about. I had a large goitre with multinodules and also a large 4.5cm nodule with Hurthle cells in it.
Even since surgery I find I just cannot wear anything high onmy neck. I have a ton of necklaces, turtle necks and scarves which I used to wear all the time, but not anymore! Even certain t-shirts I keep pulling down unconsciously and then end up ripping them off!
From what I have learned about the anatomy, and how our nerve endings seem to be, it would appear that since the nerve endings are on the skin then the nerves travel in under and past the thyroid making their way to the spine. So any enlargement of the thyroid or even post surgery as in my case, will cause irritation to the skin. It is a kind of hyper response by the nerve messages.
Having said that, that doesn't mean you still don't have a problem with your thyroid. That definitely needs investigating. The sensitivity is just an added pain in the botty!
You might need to up your Synthroid to see if that can reduce the goitre. Some people, once their goitre is reduced, are happy to find the pressure feeling disappear.
Where did the acid reflex comment then come up if that isn't something of a concern?
Sorry if I misread that but it seemed logical you were looking for a connection between the 2. - No need to use caps..
I went back to your original post and you stated you had mono.
Hashimoto's disease is also one of the leading causes of a swollen thyroid gland. This disorder is characterized by the destruction of your thyroid gland by your own immune system. The swollen thyroid occurs as it becomes more damaged and loses its ability to produce hormones.
Medical researchers continue to study autoimmune diseases, in attempt to find definitive causes for them. One virus that continues to be found in higher titers (blood measurements) among autoimmune disease patients, than in the healthy population, is the Epstein-Barr Virus (EBV). One specific medical study concludes that the association of EBV has been found in patients with autoimmune thyroiditis as well.
Mononucleosis and Hashimoto's Thyroiditis: The Epstein-Barr Virus
Hashimotos, thyroiditis, and inflammation and/or infection of the gland can and does cause this choking sensation around the throat. There are other issues that can cause it, but I have not heard of Mono patients presenting with long term pain and pressure in the throat area.
The acid reflux issue seems to be apart from the probably thyroidic problem, but in our contacts with hundreds of thyroid sufferers, it does not come up statistically more than in the general population. I believe more medical "search" and "destroy" is needed there.
As time goes by, especially watching this Board, and the comments from the many who communicate with the Foundation, it appears that more and more patients are getting the "I don't know - get moving" atttitude from their physician's. This is unacceptable and un-professional. While sometimes our symptoms are difficult or embarassing to communicate, it is the MD's job to "extract" information, and make observations of the "signs" present in a patient. This is much different from the "symptoms" a patient will present with. If the MD isn't really paying attention, committed to observation, and most importantly, committed to finding an answer to the patient's symptoms, you're going nowhere. This is the state of literally thousands, if not hundreds of thousands of folks in the US.
Not acceptable, so add patient advocate to my roll call. And we need more.
In addition, I know Buffalo is a fairly populated city, but you should not have to wait more than a few days here in Texas, even for an MD Anderson consultation. Demand quicker service, or shop around the city's suburbs or another city. These type waits are not uncommon for extremely skilled or nationally recognized physicians with specific skill sets, but routine endo visits should not have to wait 3 months. Look around, find a better deal. And don't be a victim of the system. Also remember over 75% of an Endo's time and training are dedicated to diabetes, not our thyroids.
wow, reading your description of your problem is like reading about myself. I have had this same feeling for over 4 yrs now and before. I gave up wearing turtle necks and t-shirts always feel like they are choking me. I am always pulling my shirts away from my neck as it feels like they are too tight. I do not have the redskin problem. I do or should say had acid reflux for years but have been on Omeprazol for 4 years now. It helps the acid reflux but doesn't do anything to help the neck. I have nodules on my thyroid. They were discovered 4 years ago. I have had numerous ultrasounds on them. They have doubled in number over the years. I have had 2 tests with radioactive iodine. My doctor told me they were to small to biopsy, yet they are big enough that he could feel them while examining my neck. I went to an ENT and he put the tube down my nose into my throat. He said one side of my thyroid is larger than the other. I suspect that is my problem but my doctor says it isn't. I have had a catscan. I now am going in for an endoscopy this month. I am glad to see that I am not the only one with this problem. I only brought it up to the doctor a couple months ago. I have been told to many times that I have strange complaints so I was reluctant to say anything. But I thought with the nodules on my thyroid it might explain it.. I will keep you updated and will watch for your updates also.
I am doing that too, going onto acid reflux tablets to see what happens, and anit biotics incase i have a viral infection(my idea as i heard it can linger after years after if infection was not addressed)...so fingers crossed for the tablets for refluz
I am doing that too, going onto acid reflux tablets to see what happens, and anit biotics incase i have a viral infection(my idea as i heard it can linger after years after if infection was not addressed)...so fingers crossed for the tablets for reflux
One thing that bothers me the most and that is wearing anything around my neck. I have had GERD and phobias from wearing tight things. One of my reasons is because I was wearing a winter scarf and got dragged along the floor in 6th grade by someone! The other is from watching shows wear people were strangled with necklaces by their murderer. My thyroid is fine and I also have problems with stiff necks caused by the muscles. But there are two things I think may pertain to the reason for the condition that nobody has mentioned yet.
Your lymph nodes---- they are arranged like a necklace on the base of everyone's neck. Any generalized infection could cause swelling and because they are close to the skin- any pressure could affect the nerves. I was one of those that ended up with mumps- prevaccination era- and they were really bad. The permanent effect might be because of that.
The other, the PARAthyroid. This is on the area behind the thyroid in the back of the neck. It controls calcium production. Calcium channels are found in the muscles and when a spasm occurs, the calcium floods the muscle and wraps up around it like a vice. Because the two glands are similar in proximation of each other, one could suspect the thyroid and end up the real culprit is the parathyroid. The lab results for the thyroid may reveal parathyroid levels- you might want to further investigate.
The last, I did a Google search and fibromyalgia was a cause for this. (I'm trying to wear my birthday present I got yesterday, and am resisting the urge to rip it off now!) Fibromyalgia is chronic muscle pain. Nerve endings pick up signals from axons attached to muscle fibers, blood vessels, and connective tissue. The pressure may cause the signal.
I hope this may be informative to all of those affected as well, it certainly is helping me relax, by knowing I'm not alone.
Did you ever find out what you had with your throat? Mine is the same thing. I have it all day and night, go to bed,and when I wake up I don't feel it. But then after coffee and breakfast it comes back again.
A year ago, I had a cervical CT conducted for a swollen mass on the back of my neck. Incidentally, multiple hypodensities were discovered in my thyroid. A few months later, my general practicioner, wanted me to have a follow-up ultrasound of my thyroid, which resulted in a diagnosis of NON-DIFFUSE MULTI-NODULAR GOITER. I had several small nodules both anechoic and a few solid, as well as two complex cysts in the right lobe that were close to 1 cm^3. I consulted an endocrinologist who put me on 50mcg Synthroid after I had bloodwork conducted. The bloodwork was relatively normal , except that the TSH was borderline low. I have been on the meds for 6 months now, and about a month and 1/2 ago, I began developing extreme tightness in my throat like a choking feeling, pill stuck-feeling, tightness in the back of my neck and sternum. My general practicioner had me see GI doctor, who found minor constriction in my esophagus by conducting an upper endoscopy. I had a followup ultrasound of my thyroid indicating the same findings as the previous except additional growth (+1mm) in some of the cysts. I have since been taking Prevacid, Sertraline, and Xanax with the Synthroid. I take the medications at least 4 hours after taking the Synthroid to avoid interactions among the medications. Since seeing the GI, I had minor relief from the symptoms in my neck, and they have since returned and are getting progressively worse. I am also noticing some weight gain, and I lift weights and do cardio 4-5 days a week for at least an hour. I am 29, male, biracial (black & white), and I was in good health up until a year ago...
I am curious to see if these choking/tightness/pill-feelings are a side-effect of the Synthroid...? Also, I am concerned that this goiter may be causing these issues... I am really concerned that these nodules may be forming into thyroid cancer... Currently, the doctors feel that they are too small to biopsy, and they are pretty much playing The Waiting Game... Any pointers?
I have hashimoto disease and I have recently experienced a choking sensation and pain in my neck radiating to my right ear. It is also difficult to breath sometimes, especially at night and it feels irritated in my neck when I take a deep breath almost always. Has anyone else experienced these feelings?
About a month ago I woke up and realized my voice was gone. I had redness outside my throat and never noticed it before. I was hoarse for about 3 weeks. I was having choking sensations as if something was contineously pressing against my throat. As a result I began coughing severly for minutes on end for 3 weeks. My throat was always dry. I finally went to a doctor. He checked for mucus (none) and listened to my lungs , said they were clear and gave me sinus meds for congestion.??? I wasn't congested nor was I experiencing anything he gave me meds for. I have a friend who is Hypo and said it could have been because of my thryroids. Every so often I have what seems like a lump in my throat as if a sore thorat is setting in, but it's a different kind of soreness.
Have you been checked for a herniated disc? I have this problem and I have a herniated disc with cord compression and it feel like someone is pressing right into my throat . Just a thought. Hope it helps...
I have been having the same symptoms of feeling like I am being choked. I am sometimes short of breath. Have had numerous test all normal except Cervical MRI I have a collasped disc with cord compression. My doc states it would not cause these symptoms. Maybe I should get a second opinion. Would you please elaborate on your symptoms. You are the first person who I read that might have my same issues. I have been thinking all along my disc in my neck are causing these symptoms. Thank you for any help
Did you do anything about the herniated disc and if so, did it help? I have had same issue feeling like someone had their hand around my neck. After 2.5 years and far too many doctors and tests (and hours and hours searching on the internet), my hand started tingling bad. I joke that I am now a "GMD" - a Google Medical Doctor. I had an MRI last week and have 3 herniated discs in my neck and spinal stenosis. I am seeing neurosurgeon in a couple of days.
P.S. don't ever tell the doctor it feels a bit like anxiety because that word becomes a tattoo on your forehead even if you do not have a history of anxiety or mental health issues. They will blame the neck feeling on that and shove you out the door. I accepted it as a symptom and not as a diagnosis.
I have all the same issues you posted in 2010 and have had them for years. TMJ is all it is?? How do you treat it and deal with it. Mine drives me crazy!!! I can't wear necklaces, turtle neck, some jacket, basicly anything close to my neck!
I also have the same exact symptoms. How are you treating the TMJ?
I can't wear anything around my neck at all. I had an ultrasound, which was VERY painful, yet came back normal. I am beyond frustrated!! I would love to hear how things are working for you! Thanks!
For the last few months, I have been having a problem with my neck. My right side has been causing me a lot of pain and I can't seem to wear anything close to my neck. I don't think it's my thyroid because I haven't been having any other symptoms of a thyroid problem. My eyes have been watery, my neck clicks, and my ears pop. Could this all be tmj?
hey there I have the same issues and I know its been a few years since this post,and I was wondering did you ever come up with why you were having these issues.i have went to so many doctors its not funny,as they all say the same thing:( I have went tooo thyroid spec,ent,gastro dr,endocro, spec.nothing I so tired of feeling like this,please get back to me tyvm.
I have been dealing with a strangling sensation at the base of my neck above the collar bone for 15 years now. It also radiates up the sides of my neck to my jaw and ears. I also start yawning every 1-2 minutes the whole time I have the sensation. I can tell you it is the first symptom I had that led to me being diagnosed with Hashimoto's. I had 5 nodules and an enlarged goiter cutting off my esophagus by 50%. I had to have my thyroid completely cut out in 1999. To this day, I still have the strangling sensation that started it all. It is intermittent but can last for several days at a time. I have been to all of the doctors mentioned (ENT, Endocrinologist, Cardiologist, Chiropractor, etc.), been on Synthroid for 15 years, been treated for potential causes (gerd, acid reflux, neck problems, etc.), and have had numerous tests (blood pressure, complete blood panel, parathyroid level, calcium levels, EGD scope down my throat, etc.) but nothing has helped. This sensation gets so bad that at times it feels life-threatening and I have driven myself to the Emergency room twice but it was not diagnosed. I can deal with a lot of pain but this pressure in my neck is so discomforting and annoying, I can't stand it! I've pretty much given up hope that it will ever be diagnosed or treated succesfully, but I'm glad I'm not the only one with this problem. At least I'm not crazy!
I've been dealing with this issue for a year. Seen all the other type of docs mentioned by everyone (multiple times). Ultrasound showed enlarged thyroid lobes but ENT dismissed them as too small to be causing my problems. I too have driven myself to the ER one time with the choking feeling. Was dismissed with panic attack!
I am seeing a rheumy for the first time next week. I'm also seeking an endo for the first time in about 2 weeks. My thyroid tests so far put me in low normal range.
I've had low positive tests for an auto immune disease.
I've had two other strange feelings.
The feeling in my throat changes with physical movement. Going on a roller coaster, going up a steep road like in the mountains, laying my head back on a massage table, going down an elevator, I literally could feel this sensation change during these activities. I describe it as feeling like an air bubble moving around and that it could choke me.
Also, when I had the ultrasound of my neck/thyroid, I could literally feel waves/shocks in my neck. A few times my right cheek twitch. All the docs look at me like I'm crazy when I've said that.
I get a choking sensation as well. I have nontoxic multinodular goiter. I am a 50 year old female 1 1/2 years post hysterectomy. Since surgery my weight has exploded. I am 5'6 206lbs. I am thinking weight gain might be the issue here. I cannot wear necklaces, turtlenecks etc... I have gone up at least 5 bra sizes since surgery and I feel much better without a bra on. I do not get the choking sensation without the bra. My bra straps leave indentation marks on my shoulders so it feels better with the bra off. I am thinking to discuss weight loss programs with my doctor. Since all tests and blood work have come back normal I am thinking more weight issue which is complicating my neck & back disc problems? Can anyone relate?
I have lingual tonsillitis which is causing the 'choking feeling'
I also have Hyoid Bone Syndrome - this bone can cause pain from the neck into the face shoulders etc. The bone is being pushed forward and irritated by the tonsils.
My first visit to an endo, was after I complained to my doctor that it felt as if something was in my neck or throat. She had Al ultrasound done and found a solitary mixed nodual 9mm. On the right side. And thyroid was slightly enlarged. I was sent to and endo whom was just opening up his practice. He told me there was no way it would cause this feeling and told me I had angxiety and sent me to an ENT. The ENT confirmed I was not suffering from angxiety or crazy and there were two lumps in my throat from acid reflux. And tried to do a fine needle biopsy of the nodule in my thyroid because there is a history of thyroid cancer in my family. Test results came back inconclusive and the ENT decided not to do another biopsy because of the difficulty getting to it. Said they would keep an eye on it. Almost 2 years later the nodule has grown to 1cm and odd shaped. It's not round anymore. I have not been told if the thyroid itself has gotten any larger, I think they just look at the nodule. And now my regular doctor has been running a lot of tests to find an answer to a new set of symptoms I have been having for the last few months. My BP has elevated. I have put on weight. I am tiered all the time. I have upper body pain and aches, arms, neck, shoulders, sometimes my chest. Headaches almost everyday. I feel stupid, I am forgetting things. I know I'm become depressed but don't really talk to much about that with my doctor. My feet hurt every dang day and have even resorted to puttiing supports in my shoes, I feel some Preasure on the right side of my lower neck, my cholesterol has become high, PACs and PVCs, I can't stand things around my neck anymore, I even cut my hair short, I get chest and facial flushing like I'm sun burnt, I feel weak I guess you would say, cuz I now actually have to hand a jar off to my husband to open it. My blood work, seems to not show much. Sed rates a little high. T4 low by I point. TSH within normal rang was 1.7, I thought the tsh should have been a bit higher being my t4 was low. cholesteral about 10 points above high. About a 30p weight gain. I'm growing man hairs on my lower belly, lip, chin, and neck, I pluck them out but they come back. Laying on my back at night is tough because I can not stand the feeling of my chin on my neck. I have been tested for autoimmune= neg. mono=neg, hiv=neg, rumitoid= normal, carcinoid= random pee test neg. no 24 h pee test has been done. Lyme dis= neg, gallbladder= normal, TB= neg, now it's onto an Endo again. I also did have a non cancerous golfball size tumor and lymphnod that was killed off by the tumor. Removed from my right underarm earlier this year.
TSH is a pituitary hormone that is affected by so many things that at beset it is only an indicator, to be considered along with more importnat indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T3 and Free T4. The main value for TSH is to distinguish between primary hypothyroidism (Hashimoto's Thyroiditis), and central hypothyroidism (hypothalamus/pituitary related). I'd say that you have central hypothyroidism. I say that based on your symptoms, and your minimal test result for Total T4 that is below the range.
A Total T4 or T3 test represents the total amount of those in your blood. Only a small portion of that total is free of protein molecules, thus called Free. Only the small, Free portion, is biologically active. So you should make sure they always test you for both Free T3 and Free T4 each time you go in for tests. If the doctor resists, just insist on it and don't take no for an answer. And I suggest that you should go in right away and get those done. While you are there it would also be a good idea to test for Vitamin D, B12 and ferritin. Hypo patients are frequently too low in the ranges for those as well.
When you have new test results, please get a copy of the lab report and post results, along with reference ranges. If your Free T4 and Free T3 are in the lower half of their ranges, that frequently results in hypo symptoms. That is because the ranges are far too broad to be functional for many people.
Keep in mind that a good thyroid doctor will treat a hypo patient clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important for you, not just test results. When you see your doctor it would be a good idea to find out if he is going to be willing to treat clinically as described. If not, then you will need to find a good thyroid doctor that will do so.
i dont think she was missing the symptom she was trying to help, that is what you wanted were ideas. I hope that you found or find an answer. anytime anything touches my throat i feel as if i'm choking, but i was also born with reflux, i also have what looks to be a goiter and a buffalo hump. I am only 24 and have had these issues for quite a few years now. so i understand the frustration of the dr. not paying attention thinking that it is something small.
Glad i'm not alone, the symptom is so bizzare and feels so unique. I too am unable to tolerate any clothing touching my neck. It all started around 15 years ago, was at uni at the time, so under some stress, all of a sudden one day felt a tingling sensation within my throat, it escalated into some form of spasmic attack in my neck, it became very sensitive, the sensation manifests itself from below neck to ear level. Like some sort of hypersenistive gag reflex but constant. only thing which helps me control it is having something in my mouth at all times (including night) i use an almond (less damaging than sweets). Had been diagnosed with panic disorder with globus. the second the almond is removed from my mouth the choking spasmic attack initiates. Had tried CBT which involved taking almond out my mouth and letting whatever happens, happen, but I just could not cope with the intesity of what was happening so am just living with this problem, its overtaken my life as it affects me constantly, still looking for answers even after all this time. So if anybody can relate to my symptom any advice would be appreciated, likewise if i find a solution will post.
I had a sudden onset of bizarre seemingly unrelated symptoms. Left arm numbness/tingling, severe throat choking sensation, LPR symptoms, back/muscle pain, fatigue etc.
The doctors said it couldn't be my thyroid but it seems it is just that. My throat choking is spontaneously disappearing with NDT. I spend thousands out of pocket for endoscopy and other tests because they said it could not be my thyroid without a goiter. The lymph on my left throat swells so much it pushes my trachea over slightly. They thought I might have cancer. I've just started NDT (2 months or so now) and the swelling is better.
Seems they were wrong this couldn't be thyroid. I can't explain it either like my one arm problem, it seems impossible but obviously it isn't.
I was having the same thing for a couple years. I had my labs done...normal. I had ultrasound done...normal. I asked my doctor to switch me to Armour. It worked. Ok, a couple years down the line....It's happening again. I'm wondering if it's an allergic reaction to the fillers in the meds. I'm wondering if now that Synthroid is out of my system if I could try going back to that and seeing if it would disappear.
I took a Claritin D a few hours ago and my neck isn't hurting. I really do believe it's some sort of allergy we are having to our thyroid med fillers, because it's that pill that would go direct to the gland.
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