Thyroid Disorders Community
Enlarged Face and Neck
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Enlarged Face and Neck

I have had Hashimoto's Thyroiditis for decades. I am on Armour Thyorid. My blood tests are in the "normal" range. However, I'm having problems with a puffy moon face and very enlarged neck. I spoke to the doctor about it and he said I do not have a goiter or nodules.

Does anyone else have this problem? If so, what do you do to treat it? I just want my normal looking face and neck back.
Tags: Hashimotos, Enlarged neck, Moon Face, Thyroid, Hypothyroidism, puffy face
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16 Comments Post a Comment
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Avatar_m_tn
Please post whatever thyroid  related test results you have, along with reference ranges shown on the lab report.
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Avatar_f_tn
OK, I just had a physical September 2010. I won't post everything only the stuff related to thyroid:

TSH, (3rd Generation) (High Sensitivity):  0.32

T4, Free, Thyroxine, Free, Direct:  1.2
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Avatar_f_tn
If you're on Armour, your doctor absolutely should be testing FT3 as well as FT4 and TSH.  Is FT3 on your lab report?

This may sound like a stupid question, but are you on steroids?
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Avatar_f_tn
The only thyroid related test results of my physical in September 2010 was:

TSH, (3rd Generation) (High Sensitivity):  0.32

T4, Free, Thyroxine, Free, Direct:  1.2

There was no mention of FT3 or FT4. TSH is there as stated above.

No, I'm not on any steroids unless you want to consider Flonase, which is a nasal spray for hayfever and that wouldn't cause a puffy moon face or enlarged neck.
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Avatar_f_tn
Isn't T4, Free, Thyroxine, Free Direct the same as FT4?
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Avatar_f_tn
T4, Free is the same as FT4.  What's the reference range on that?  Ranges vary lab to lab, so you have to post them along with results.  It's FT3 that your doctor should be testing and isn't.

"Fluticasone propionate, the active component of Flonase Nasal Spray, is a synthetic corticosteroid..."  Corticosteroid...steroids do cause the moon face you describe.  I'd ask my doctor if that might not be the problem rather than your thyroid.
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1202943_tn?1347844252
One of the biggest physical indicators when I'm hypo is swelling of my lower face and upper eyes.  But, yours could be caused from flonase.

When I was on prednisone my face got really huge!

Check out my photos on my page.
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Avatar_f_tn
OK, thank you. Next time I'll ask the doctor to please check my FT3. He's a general practioner and not an endocrinologist so I have a feeling he doesn't really know that much about Hashimoto's. I moved 400 miles away just recently (due to family issues) and I have all new doctors. The odd thing about living in this area is that unlike where I lived before, I can't just go to an endocrinologist on my own. In this area endocrinologist only see patients who are referred by their primary doctor and who have medical insurance. I have no medical insurance and the endocrinologists here do not take private pay patients. There are only a handful of endocrinologists within a 200 mile radius because this is a very rual area in the mountains and it's a very small town. So I'm rather stuck with what I've got for doctors.

Here are the lab ranges and what I tested and like I said, no mention anywhere on my lab tests of FT3:

TSH, (3rd generation) (High Sensitivity)
I tested at: 0.32
Normal range is: 0.40 - 4.50

Although this is considered low, my doctor doesn't seem to feel it's anything to worry about so he is not addressing it.

T4, Free, Thyroxine, Free, Direct
I tested at: 1.2
Normal rage is: 0.8 - 1.8

I'm concerned because I'm not able to lose weight. I still have a lot of the so called thyroid looking effects such as moon face, enlarged neck, swollen tongue with scalloped edges, puffy eye lids, buffalo hump at the back of my neck, so much hair loss that I have a baseball sized bald spot on the top of my head (and I'm a woman so this isn't good at all!), hair chanced color from natural auburn to gray-white within a short amount of time an changed texture and is now very thin. I also have brain fog, body aches, chronic fatigue and depression. I think this might all be due to my thyroid. Yet my doctor seems to think I'm doing fine because he likes my lab results.

I also have a number of other factors going on...I've got type 2 diabetes, high blood pressure, high cholesterol, high triglycerides and GERD.

I'm on medication for diabetes, high blood pressure and high cholesterol and for my GERD. However, the doctor seems to be reluctant to do anything about my very high triglycerides. Also my blood sugar is not being well regulated with the medication I'm on. Last week I went back to my doctor and told him that I'm concerned about all this and he said and I quote..."Give it another three months and then well do some more lab work and we will address it at that time."

I'm frustrated because I know my puffy face, thick neck and all the other stuff going on with me needs to be taken care of and at this point I just don't know what to do.
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Avatar_f_tn
Your FT4 is a little on the low side.  Midrange is the target for FT4, so yours could be a little higher.  Your FT4 isn't terrible, so it's very likely that the answer to why you still have all the hypo symptoms lies in your FT3 levels and poor conversion.  

Inability to lose weight is a hypo symptom, as you know. So are hair loss. brain fog, body aches, fatigue and depression.  "Yet my doctor seems to think I'm doing fine because he likes my lab results."  Don't let him ignore your symptoms.  He may "like" your labs, but he doesn't have to live in your body or with your symptoms.   Did you know that HBP, high cholesterol and triglycerides and GERD can all be symptoms of hypo rather than separate conditions?  Many people find these conditions resolve when thyroid meds are adjusted properly.

"I still have a lot of the so called thyroid looking effects such as moon face, enlarged neck, swollen tongue with scalloped edges, puffy eye lids, buffalo hump at the back of my neck..."  I'm not saying that these symptoms are not caused by hypo, but they are not typical hypo symptoms.

Here's a link to a site describing the causes of moon face:

http://www.webmd.com/a-to-z-guides/moon-facies

"A high release of hormones, especially cortisol, is a cause of moon face. This is called hyperadrenocorticalism or hypercortisolism. The adrenal glands, triangular-shaped glands that sit on top of the kidneys, release the cortisol."

"Symptoms usually occur as the result of long-term use of oral steroids. But less commonly, injected or inhaled steroids may cause Cushing's signs and symptoms, too."

More from Mayo Clinic on the symptoms of Cushing's Disease.  Cushing-like symptoms can be caused by the use of steroids:

http://www.mayoclinic.com/health/cushings-syndrome/DS00470/DSECTION=symptoms

I'd really question my doctor about this.  It's possible that some of these symptoms are being caused by the interaction of your steroid inhaler with thyroid meds.  

If you get your FT3 tested, you can post results, if you like, and we can help you interpret them.

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Avatar_f_tn
Thank you for all your help! Yes, next time I go to the doctor I'll request to have my FT3 checked and post it with the lab range here.

I've often wondered about Cushing's Disease. Another symptom I'm having is facial hair growth. I have started to grow a white mustache and beard. It grows in so fast over night that I have to shave like a man every morning. I've spoke to the doctor about this and his reply was, "You are fat. Fat has lots of testosterone in it. Excess testosterone can cause facial hair growth in women. Lose the weight and you won't have this problem."

Really? I'm fat? Gee, no kidding. (Rolls my eyes) It never ceases to amaze me that people think they are telling me something new and act as if I have purposely chosen to be fat. Believe you me, if I could lose the weight, I would. I hate being fat. It's unhealthy, looks unsightly, can't get clothes to fit, it makes me feel awful both physically and mentally. I never had any weight issues until my thyroid went bad. I used to weigh 95 pounds and wore a size 3 (I'm tiny only 5 feet tall). I could eat anything I wanted and never worry about my weight. But at age 16 suddenly I gained a ton of weight in about 3 months. I was very active. I was walking to school, walking around campus all day. I got up an hour before I had to so I could do aerobics. I participated in lots of school sports and then I went home and did aerobics and then I would ride my bike, skate, play ball, etc. after school. I was constantly on the move. Yet, with all that exercise I suddenly gained 150 pounds in a matter of months. Yes, that sounds impossible and people who weren't around me and hear this don't believe me. But it's true. Since then I have struggled with weight. Even though I had a huge weight gain and all kinds of odd symptoms, no one diagnosed my Hashimoto's until I was 40 years old and then it was purely by accident that it was diagnosed. I am now 49 years old and I have been on Synthorid and that didn't help with my symptoms of being cold, tired and achy. So I went on Armour. Armour got rid of the always cold feeling, but I still have lots of symptoms. Believe me; I have tried tons of things to lose weight. When I'm not so exhausted and achy that I can't get out of bed, I do low impact aerobics and I walk. I have tried The Zone, Atkins, Scarsdale, Optifast, Nutrisystems, Jenny Craig, Weight Watchers, etc., etc. I also went to a "fat farm" where you are dropped off at a rural camp and left there for several months without your car and they lock you up in your room and/or cabin and only feed you very small nutritiously balanced calorie restricted portions. The kitchen is locked up and only those with a key or the lock combination can enter and they lock you in your room/cabin at night so you can't sneak out and cheat. The fat farm had a boot camp type trainer exercise me nearly to death. And guess what? I actually GAINED weight with all of these methods even with the fat farm and the medically supervised Optifast!

When I read the symptoms of Cushing's Disease I think, yeah OK, maybe I have that...but usually with Cushing's Disease a person has thin arms and legs and central body fat. I am fat all over, but yes, the majority of my fat is in my belly. Yes, I’ve got the moon face and enlarged neck thing happening, but I’m not sure if it’s my thyroid or the steroids from the Flonase or Cushing’s Disease or something entirely different is going on. The trouble is trying to get my doctor to do something about it. Living in a small rural town in the mountains I’m limited to the few medical providers we have. I would have to travel over 200 miles out of my area to have access to other providers. Being I have no medical insurance is another issue because I can’t afford a lot of testing. I’m just not sure what to do but I’m sick and tired of being sick and tired.

Again thank you Goolarra for your help and advice. I will post my FT3 and the lab ranges when I have the test done.
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Avatar_f_tn
I'd sit my doctor down and have a discussion with him about Cushing's.  Point out every symptom you have of it, and make sure he sees what you're talking about.  If you have Cushing's, you shouldn't be on any kind of steroids.

If your thyroid hormones aren't right, it can be almost impossible to lose weight, and if your adrenals are compromised (Cushing's), it can be next to impossible to regulate thyroid meds.  You don't have to have EVERY symptom of a disease to have it...thank goodness, because some of those lists of hypo symptoms are about a mile long.  

One of our members, gimel, has a list of doctors recommended by forum members.  Where do you live?  He might have a suggestion for you.  It might be worth the 200 mile drive.  I know it's not easy, but you have to get well.
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2114432_tn?1334456132
To make your puffy face go down eat nothing but vegetables and fruit and drink water. Stay away from anything white or you will gain weight fast.
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Avatar_f_tn
Thank you, however I'm diabetic, have Irritable Bowel Syndrome (chronic diarrhea) and have severe food allergies. The ONLY food I can eat that doesn't cause me troubles are white bread, white rice, potatoes, pasta, eggs, fish, chicken, turkey, lean beef, pork, lamb and dairy products. Sadly this conflicts with my diabetes. Yet if I try to eat ANY fruits or vegetables or brown breads or brown rice my IBS (Irritable Bowel Syndrome) kicks in and I get horrible stomach cramps where I'm doubled over in severe pain and explosive liquid diarrhea for days. I've been to numerous doctors, internists, gastro doctors and given all kinds of medications and special diets and nothing has helped with my IBS accept eating very bland foods and most of them are the white foods like white bread and white rice. And yes, I drink TONS of water because I'm chronically thirsty all the time with my diabetes. I need lots of protein for my diabetes to keep my blood sugar low enough and so I have to eat lots of animal products. I am allergic to soy and corn and beans upset my IBS. By the way, I gain weight even on a liquid fasting diet of 500 calories a day. I was put in a fat farm and locked up and not allowed access to food. I was forced to do heavy exercises boot camp style every day. On this liquid fasting diet and being locked away from food and made to exercise like crazy I gained 17 pounds. I was tested and it was found that because of my auto-immune thyroid problem I have barely any metabolism at all and that my body does not burn calories but stores them as fat. All the doctors and nutritionist I've been to have tried to work with me but have been stumped and unable to fix my problem because my body just seems to naturally gain weight at a severe rapid rate even when I eat a normal amount of calories and get plenty of exercise. This sort of thing runs in my family. All my cousins are obese. I have one cousin who weighs 500 pounds and is only 4 foot 9 inches tall. So it seems that my weight issues are from my auto-immune problem that the doctors are unable to correct even with proper medication, diet and exercise and my weight problems are also a genetically inherited problem.
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Avatar_f_tn
Just went through a bunch of testing for Cushing’s a few weeks ago. Turns out I do not have Cushing’s. All they have determined is I have diabetes, high blood pressure, high cholesterol, glaucoma, sleep apnea, Hashimoto's Thyroiditis (an auto-immune disease of the thyroid that causes hypothyroidism/low thyroid), Irritable Bowel Syndrome, food allergies, hay fever, psoriasis, Lupus, Chronic Fatigue Syndrome, Fibromyalgia, bone spurs in my feet and back and neck, Carpel Tunnel, social anxiety disorder, clinical depression and I'm obese. Yes, I'm a mess. Oh well. It is what it is. Everyone has some cross to bear and I guess my health issues are my cross to bear.
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Avatar_f_tn
Check out low dose naltrexone. This could be a really good thing for you - start slow at 1.5 because you may have to lower your thyroid meds on this.
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Avatar_f_tn
Thanks for the post, but ummm...why would I try Naltrexone? I don't drink and I don't have a drug problem. It's used to help patients with alcohol problems by keeping the body from wanting alcohol. Also helps narcotic dependents who have stopped taking narcotics to stay drug-free. This medicine is part of a recovery program that includes medical supervision and counseling. Naltrexone may cause liver damage when taken in large doses.
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