goiter swelling

[mommy2two2008]

Dr. Lupo~

I have a thyroid goiter measuring Right: 5.3 x 2.0 x1.4 cm - Left: 5.0 x 1.3 x 1.6 cm.  It is "heterogeneous echo texture seen without discrete focal lesion, similar finding present on left".  No focal suspicious lesions identified.  Per US dated 4/8.  Blood levels were considered "normal": Free T4 1.45 (.73-1.95) Ultrasensitive TSH 1.040 (.3-5.1) TPOab: <10 (<35).

Now every time I try to be active, whether cleaning my house or mowing the lawn, this goiter swells.  It does not hurt, the muscle (I think the sternomastoid muscle) over the thyroid sometimes hurts when I turn my head though.  I have ear fullness and a feeling of swollen glands along the right neck.  

My question is why would the goiter swell with exertion and why do I get the other neck swelling feelings (ear fullness, muffled hearing, kind of burning way in the ear) at the same time?  I have contacted my endo and his office just suggested I keep my June 6 appointment.  

The goiter is more noticable to me now and shirts and necklaces now bother it.  Any opinion you have on the subject of swelling with exertion would be appreciated.  This goiter has been around (at first notice) since the end of March.

[898]

Excessive consumption of fluoride (in drinking water or tooth paste), the perchlorate contamination of the drinking water or flame retardant used in the new upholstery may reduce ability to trap iodine, making “displacement” iodine deficiency

[Mark Lupo, M.D.]

With the normal TSH, the levothyroxine is not likely to help and may make your hyperthryoid.  Would consider screening for iodine deficiency (NOT common in USA) w/ urine iodine test.  First see if the antibiotics help.

[Anniegirl56]

Hey there, I just thought I would let you know that I am experiencing the exact same thing!  My thyroid measured approx. 5.9 (length only as I don't have the actual report but I recall this measurement on both sides).  I was placed on Synthroid in efforts to shrink my goiter and was told that my TSH was on the low normal side with T3 and T4 in the normal range.  I am having pain just above my goiter on the left side just below the jaw line in front of the ear.  I don't have pain on the swollen area though it looks a little odd with two lumps on one side of my neck and one lump on the other.  I am having slight pain and fullness feeling in my ear.  I wonder if the pressure of my goiter is causing this but I can't find anything to justify that thought.  I don't know if I should go to the doctor again or just wait to see the Endo in July.  I just wanted you to know that your not alone.  If I were you, i would take the Levothyroxine to see if it helps.  I hope you feel better soon.

[mommy2two2008]

As an update.  I attempted to see my ENT for ear fullness and neck lymph nodes in the upper portion and his office called back to inform me they made me an appointment with a surgeon.  Very long story short -- The surgeon said I have swollen lymph nodes under ear, under the jaw and full feeling ones over the jaw right in front of the ear that may simply have nothing to do with the goiter.  He gave a prescription for antibiotic and made a followup appointment for June 10.  Do you think whatever infection is in my nodes could be the problem with my thyroid?  He also indicated I needed to starting taking the levothyroxine the endo prescribed.

Thank you in advance for your input.

[mommy2two2008]

Thank you so very much for your response, I sometimes feel like my doctor thinks its all in my head - when really its all in my neck!  Another question or two if you do not mind.... would this mean that I will have this forever?  I have read that Hashimoto's is something that eventually makes a person go hypo and stay there.  Also, what additional testing do you think is appropriate given the additional symptoms of ear and neck lymph nodes?  

Again, thank you so much for responding.  I really appreciate it - we only have one endocrine doctor in our small town and honestly, I think he is way overworked.  He also treats the surrounding rural areas.

[Mark Lupo, M.D.]

The ultrasound description sounds like hashimoto's (despite the normal TPO antibody level).  Intermittent swelling is sometimes reported but not understood, nor is there any treatment for this given the completely normal TSH (ie, levothyroxine not appropriate in this setting).  I wish I had some better advice.  Making a definite Hashi diagnosis would require FNA biopsy -- there is a condition called painful-variant Hashi that usually gets better with time but rarely would require thyroidectomy (surgery) to treat.