thyroid nodule

[kcr01]

I am beginning to think I have something like a paralyzed vocal chord and wonder if it's caused by a thyroid nodule or someting.  Does anyone know if this can happen, and any suggestions on where to go next?

I have many symptoms of a thyroid disorder and thyroid disorders run huge in my immediate family.  
A few years ago I had a complete thyroid panel done and was told my thyroid was normal.  Those results were a little off, but I'm told they did not indicate any thyroid disorder.  First one doctor tested just my TSH, T4 and Free T4.  TSH was 1.1, T4 was a tiny bit high at 13.0 but Free T4 was in range at 1.4.
About a month later I was sent to an endocrinologist and the tests he ran were also a bit off but described as normal labs:  TSH 2.1, T4 12.5 (slightly elevated), T3 Uptake 20.5 (low), FTI 2.6, Free T4 .9 (normal-low), and T3 total 224 (high).  Antibodies were negative.  None of these labs suggested a specific thyroid disorder.  My thyroid was firm and prominent, and I complained of a feeling of fullness in my throat but they never checked for any nodules at that time.  

I think they were more reluctant to pursue thyroid problems because I was neither overweight or underweight, and my main symptoms are fatigue, concentration issues and sensitivity to cold (and extremely cold hands).  I had no "severe" symptoms of a thyroid disorder (even though the run down/fatigued feeling IS severe), so no one thought it was worrisome.

I "lived with it" for a few years and then decided to pursue it again.  Still fatigued, brain feels slow, hair now thinning, and when I got off the pill for a short time I never got a menstrual period.  My throat was still feeling "full" and I was beginning to lose my voice at the end of the day, even if I hadn't been talking much.  I was told it was "probably allergies."  My TSH in 2007 was 1.79, so they ran no other tests.

A year later my TSH was 1.17, normal again, so no other tests were run.  At the beginning of this year I went to my primary and again explained that my voice was getting hoarse quite often.  She said my thyroid felt enlarged so she sent me for an ultrasound.  A week later I got a letter from her saying my thyroid was in fact not enlarged and I had a small nodule in the upper right pole that was not worrisome.  End of story.  I never saw the ultrasound report so I don't know the measurements or any characteristics.  

4 months later and my voice is still getting hoarse quite often.  I often feel like my throat is "strained."  It's not pain like strep throat, but just feels weird.  And my thyroid to me feels very firm and big, but like I was told, it's not enlarged.  My primary has suggested no follow up.

I have suffered such fatigue and body weakness in the past few years that I first thought I was losing my voice simply from sheer tiredness, like even my vocal chords were weak.  (Everything else including depression has been ruled out.)  It could very well be allergies (though I don't really have terrible allergies).  It could be GERD (but I rarely have a feeling of acid reflux, and when I do I can pinpoint the specific food that caused it).  It could be any number of simple things, but I wonder if that "small nodule" is possibly causing my voice to get hoarse somehow?  Could it be pressing on a vocal chord or something?  Is an ear, nose and throat doctor my best next step?  (I WILL NOT have luck on my own getting anyone to test my thyroid again considering they feel those past labs were normal.  But my hope is maybe if an ENT sees that my thyroid is causing throat problems he can suggest something to my primary about running more tests.  Of course, if he sees nothing then I'm still absolutely clueless as to what the heck is wrong with me!

[NAVCHAPDOC]

First, thank you all in advance that offer advice and answers. I am going to me posting this message on several sites so please forgive the repeated requests. Here is my problem(s) I am a 37 year old male. About a month ago I started getting a horse voice with a very mild sore throat mostly on the right side. After about a week I started getting an intermittent “ripping” pain / sensation in a very specific pin point area in my throat near the top of the thyroid /vocal cords.  I was also getting stabbing pains in my ears and bottom of my jaw and under my tongue. The pains continued to my clavicle area as well. I should mention that the pains I mentioned almost never happened all at the same time. It was one or the other. The pains would last for anywhere between 30 seconds and 2 minutes.

  So I went to my PCP and dumped the symptoms in his lap and he sent me in for an ultrasound of the thyroid and well as lab work. The labs on my thyroid came back fine but borderline for hyperthyroid yet still in “normal” range. I am overweight and have been for some time so not much concern there.  The US however showed a 1.4cm nonspecific nodule in the right pole of my thyroid. When the doc told me of the findings I asked him if the nodule could be causing the symptoms I was having. Before I tell you what he said, keep something in mind here…I used my index finger and showed him EXACTLY where my throat pain was when I had my first appointment with him a week earlier. The same area I pointed to was precisely where the nodule was found. He said that there was no way that the nodule was causing my symptoms. I went to an endocrinologist and was told the same thing. I also went to an ENT who scoped me to see my tongue, airway, nose, vocal cords ect. He said my vocal cords were slightly inflamed but that shouldn’t cause my symptoms. He also said that the nodule couldn’t be the problem either. I took it a step further and had a barium swallow done which was normal.

As the weeks pass, the pain is getting more and more frequent. Here is my question… Is there anyone out there that had a nodule that caused the same problems I am describing? Did removing it make the symptoms go away? I am at the end of my rope. I feel like because I am young and appear “healthy” that the Dr’s don’t take me seriously or feel concerned because I don’t fit the age mold for someone with these types of problems.  I am having a needle biopsy of the nodule in a few weeks.

[Anu0506]

I agree with  MANmom, you need to find a good ENT. Here is my story, made it short though. After my thyroidectomy, my vocal cord was damaged. The right side was paralysed. I could not project my voice. Eventually , I gave up. My ENT told he will help me. He directed me to a Speech Therapist. There i went for my speech theraphy on regular basis. He gave me a period of 6 months, after which he said if my voice is still bad, he will do a surgery to get my voice back. Not sure how but a MIRACLE happened. After the 6th month, he scoped me and there, my paralysed vocal cord was working. Here I am, my voice is not perfect but improving. That is why you need a good ENT to help you. Good luck! :)

[MANmom]

kcr01...I feel your pain.  I have had almost the exact same experience...Here is my story:

I am 44, female, and have known that I had nodules since 2002, probably had them before that.  I am a singer and a voice teacher.  I started getting hoarse after rehearsals, it lasted only an hour or so, then I would wake up fine.  Finally this fall (08) I started having thyroid symptoms, hat/cold, night sweats, tired, blood pressure spiked, wacky cycles, weight loss, and my hoarseness started getting worse.  I also had some difficulties swallowing, I would eat a bite, it would get stuck half-way down, then I would get horrendous hiccups that were very rapid and feel like I was going to choke.  That lasted until I washed it down with water, but it hurt and felt like it was going to explode my throat.  My thyroid labs were fine, although I did have a positive THOab suggesting Hashi's.  My dad had Hashi's, and two of my older brothers have it too, looked like I was going down that road.  But the hoarseness was really bothering me.  

By Christmas 08 I had to quit singing in my semi-pro chorus, that killed me.  I had an ultrasound, I had four large nodules, three in the right and one on the left.  The largest was 2.1cm, the smallest just under 1 cm.  All were smooth and round, well encapsulated, and were solid and vascular.  The ENT ordered a FNA biopsy, they only found benign follicular clusters which did not tell us if I had cancer or not, the only way to know was to take the nodules out.  I did not really want to do that, I had good thyroid function, at least for now, so I made a decision to wait.  Only then I had a weekend wrestling tournament for one of my sons that I attended, I concentrated very hard NOT to yell, when I went to bed Saturday night tired, but my voice was fine, but woke up hoarse and stayed that way for 5 days!  That was it.  I truly believe that these nodules were squeezing off my vocal nerves, so I thought that now I wanted to try to remove at least the right side of my thyroid with the three large nodules it in.  My thought was if they were the problem, then when they came out I would be singing again and I may still have thyroid function, at least that was worth the gamble...My surgeon was the BEST!  He left a thin film of thyroid tissue around the vocal nerves to protect them from damage, and stiched me back up.  I went home the next day, feeling fine...almost no pain, my voice was in tact, a little weak in the mid-range, but there.  Within 5 days I was walking 3-4 miles and started singing exercises to strengthen my voice.  It came back fully, although I wasnt' pushing it, I practiced a few minutes every day.  I was happy and I felt good!

But then the shocker...at my 2 week post-op, the surgeon told me that I have papillary cancer, they found three small microcarcinomas in the thyroid tissue itself, not in the nodules.  So in two weeks, I will have the remainder of my thyroid removed, then probably RAI treatment to kill the tissue he left to protect my vocal nerves.  But at least now I know!  It is the not knowing that was driving me crazy!  They also diagnosed GERD, of which I was skeptical at first.  I did not have any pain, but I coughed a lot after eating and did have a lot of phlegm.  So now I am on prilosec, and it does help.  They scoped my throat and my vocal chords look great, but I did have a little irritation due to the phlegm.  At least now we are on the right track!

I suggest you see an ENT, there are tests for GERD, but depending on the size of the nodule, that may be your problem...only 5-15% of nodules are cancerous, mine were not, but the thyroid tissue was.  If the nodule is causing you trouble, find out it's characteristics...ask for the radiology report and sometimes you can get a copy of the actual ultrasound, I did.  If it is only one, you might consider having it removed only on the side it is in, so that if it is causing the hoarseness you can get it taken out without losing thyroid function.  Only about 20% of patients who undergo a lobectomy lose thyroid function.  But if you do, and I stress this after doing the research, GET THE BEST ENT YOU CAN GET!!!  He must be one that does at least 50 thyroid surgeries a year, and willing to show you his statistics on complications.  The surgery has many risks, permanent hoarseness is one of them.  I hope this helps you, good luck!