Avatar universal

I have questions regarding my neck pain and thyroid

I have Chronic neck pain which recently has got worse, started to get more anterior with pain around neck I have few buldging disc and arthritis in neck. I’m 38 yr old female. My dr ordered U/S of neck. It showed my thyroid gland was heterogenous without focial abnormalities. Right lobe measures 4.3 x 1.9 x 2cm left lobe 3.9 x 1.6 x 1.5cm isthmus 5 mm. My TSH 3.33 my doctor says U/S is normal. From what I have read it is not normal. Then ordered C/T soft tissue neck with contrast, results showed no abnormalities so I’m just confused.?? Should I check more into my thyroid ? Or just watch and wait for any new symptoms ?
9 Responses
1756321 tn?1547095325
A heterogeneous thyroid gland means the texture of the thyroid gland isn't uniform and smooth. This finding has been associated with diffuse thyroid disease including Hashimoto's thyroiditis and Graves' disease.

I had a sore throat from Hashimoto's thyroiditis. This pain went away taking thyroxine.
Thank you
649848 tn?1534633700
Is TSH the only thyroid-related blood test you've had done? Ask your doctor to order Free T4, Free T3 and the antibody tests, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  

Free T4 and Free T3 are actual thyroid hormones and will determine if you have hypothyroidism.  The antibody tests will confirm if you have Hashimoto's and if so, even if you aren't hypo now, you probably will be at some time in the future.  

I didn't necessarily have sore throat, but I did have a goiter (swollen thyroid w/nodules) and it was often quite uncomfortable.  It still sometimes "flairs" and is uncomfortable, even though I've been on medication for 10 yrs...

You do need further tests, IMO.
Yes only thing he checked was TSH.  Thank you for the information
Avatar universal
Yes, you should get thyroid hormones and both antibodies tested. This could be Hashimoto's and systemic inflammation causing your recently increasing neck pain. With TSH at 3.33, it is climbing up towards the top of the lab range. If you're in the US, many labs use 4.0 as the top of normal. Many people are hypothyroid with a TSH even over just 2.0, if their FT3 and FT4 tests come back low in range. TSH that high, your US results, plus symptoms possibly related means you need complete thyroid labs to find out exactly what your thyroid is up to.

I have Hashimoto's and I also have neck problems, too. Hashimoto's and other autoimmune diseases are very sensitive to inflammation. When my antibodies increase, my inflammation increases, and I often have increased neck issues. Once my antibodies start to decrease, my inflammation decreases, and my neck issues also usually subside. I do about everything I can think of to keep my inflammation at a minimum. Gluten free is recommended for autoimmune problems, and so are dairy and soy free. All three cause inflammation. Besides those three, I don't eat goitrogenic foods very often unless they are well cooked to reduce their thyroid hormone reducing qualities (cauliflower, Brussels sprouts, broccoli, kale, etc), and I also steer clear of nightshades. Other things that cause inflammation in the body are any sort of illness, injury, and exposure to any substance that causes an immune response.
I do have several symptoms of Hosimotos. Since my TSH was in range and ct of soft tissue neck did not show anything my doctor told me everything is normal and not to worry. I’m going to request a thyroid workup . I do have IBS with constipation and GERD and lately it has been worse as well. I think it is due to all the salads I have been eating!! I did not realize certain vegetables could cause all the inflammation! I’ve been eating a lot of raw broccoli and tomatoes!  I’m going to have to do more research on this, thank you so much for all the info!
Hashimoto's symptoms can be similar to those who are just hypothyroid, but not always. TSH (hormone from pituitary) as high as yours in range is concerning because it can correlate with low thyroid hormones T3 and T4. Heterogeneity means your thyroid is not normal because does not have the smooth texture and uniformity of a healthy thyroid, Red Star mentioned first. Determining the exact cause of heterogeneity requires thorough testing.

Broccoli is a goitrogen, meaning it can interfere with thyroid function. Raw is worse that cooked, but cooked still contains the same mechanism to interfere with your thyroid but to a lesser degree. Tomatoes are in the nightshade, inflammation causing family. You're welcome! Good luck on your thyroid labs.
My mother loves tomatoes! As she went into remission with Hashimoto's thyroiditis it seems nightshades are getting a bad reputation as inflammatory. There is no scientific evidence to show nightshades cause inflammation. Just anecdotal reports. So you can try avoiding nightshades to see if you notice an improvement but don't be surprised if you don't.
Certain alkaloids in nightshades can irritate and inflame the gut and cause joint pain in some people with inflammatory conditions. That's great they don't bother your mother. I love tomatoes, too, but I cannot eat them unless I want to enjoy sharp joint pains and gut pains for awhile. Maybe it's because I have arthritis in a few joints that it bothers me. Everyone is different. If someone suffers from inflammation it's worth trying to eliminate foods that might be the cause for 30 days or more. Same goes for gluten or any other inflammatory food. Try 30 days elimination, see if you feel better. Try reintroducing, see if you have any reactions.

There are studies, but most are on animals. There are some studies on humans on alkaloids and their effects on inflammation.

Not inflammation, but I found a 2016 clinical trial on fatigue in autoimmune MS and following a paleo diet. The National Multiple Sclerosis Society launched a $1M clinical trial with University of Iowa on the effects of diet on fatigue in MS. One of the diets, a modified paleo diet called The Wahls Protocol, doesn’t include nightshades, grains, eggs, dairy products or legumes. The diet places heavy emphasis on vegetables, fruit, meat and fish.

2017 psoriasis (autoimmune) survey showing improvement in symptoms when reducing nightshades, gluten and alcohol in the diet.


An older study on nightshades done on 1400 volunteers over a 20 year period and a survey of 5000 people with arthritis who sustained from nightshades and had a 68% improvement. Long list of references at the bottom.

Study on potatoes aggravating inflammation in the gut and disruption of the intestinal barrier
WebMD states there are no studies. Hmmm. Good to know. :)
Red_Star... This from WebMD - note the last paragraph:
"Anti-Inflammatory Diet: Road to Good Health?
In this Article

    What to Eat
    What Not to Eat

If you have a condition that causes inflammation, it may help to change your eating habits.

While medication and other treatments are important, many experts say that adopting an anti-inflammatory diet may help, too. If you have, say, rheumatoid arthritis, changing what's on your plate won’t be a magic cure -- but it might lessen the number of flare-ups that you have, or it may help take your pain down a few notches.

An anti-inflammatory diet is widely regarded as healthy, so even if it doesn't help with your condition, it can help lower your chances of having other problems.
What to Eat

In a nutshell, anti-inflammatory foods are those that any mainstream nutrition expert would encourage you to eat. They include lots of fruits and vegetables, whole grains, plant-based proteins (like beans and nuts), fatty fish, and fresh herbs and spices.

Fruits and veggies: Go for variety and lots of color. Research has shown that vitamin K-rich leafy greens like spinach and kale curb inflammation, as does broccoli and cabbage. And the substance that gives fruits like cherries, raspberries, and blackberries their color is a type of pigment that also helps fight inflammation."  

I guess they can't make up their minds...  lol
Figures lol.
Well my TPO came back at 29, and free T4 0.8, doctor says no treatment needed at this time !  
649848 tn?1534633700
"Nightshade Vegetables and Inflammation: Can They Help with Arthritis Symptoms?

    Potential health benefits
    So what’s the verdict on nightshades?
    Anti-inflammatory options
    Inflammatory foods to avoid

Not all nightshade plants are safe to eat

Nightshade vegetables are members of the Solanaceae family of flowering plants. Most nightshade plants aren’t edible such as tobacco and the deadly herb, belladonna.

A handful of nightshade vegetables, however, are edible and well-known staples in our diets, including:


All nightshade plants contain compounds called alkaloids. One alkaloid found in nightshade vegetables, solanine, may be toxic in large quantities or in a green potato. There’s no evidence solanine is harmful in typical food amounts. And solanine isn’t only found in nightshades—blueberries, huckleberries, and artichokes contain it, too.

Thanks to anecdotal evidence, nightshade vegetables have earned a bad reputation for causing inflammation in the body. But not everyone with painful joints who eliminates nightshades from their diet experiences pain relief and some evidence suggests that the nutrition content of nightshades may help with arthritis symptoms.

Keep reading to learn how these vegetables may affect inflammation within the body, their potential health benefits, and more.
What the research says about nightshade vegetables and arthritis

According to the Arthritis Foundation, the belief that eating nightshade vegetables worsens arthritis is a myth. They claim people with arthritis may benefit from the high nutrition content in nightshades.

For example, researchers in one 2011 study found that inflammation and DNA damage was reduced in healthy men who ate yellow or purple potatoes, which are nightshade vegetables, for six weeks.

However, more research is needed. To date, there’s little scientific research to draw a conclusion either way.

Health benefits of popular nightshades

Most nightshade vegetables contain an abundance of nutrients. They’re also readily-available and easy-to-prepare. In some cases, the benefits of eating nightshade vegetables may outweigh any inflammation risk..."


The same applies to the goitrogens... they have so many nutrients that most of us can't afford to eliminate them from our diet.  If the goitrogens are separated from thyroid hormone medication by several hours, most of us find that we don't have a problem with eating them, particularly if they're cooked, since cooking destroys the goitrogenic properties.

If one finds that they're sensitive to a food/food group, such as dairy or gluten, they should, by all means eliminate it or reduce consumption, otherwise there's no real reason to do so as the science simply isn't available yet to prove that they cause problems for every one.  The suggested elmination diet is the best way to find out about sensitivities.

Sugar, on the other hand, has been proven to be one of the most inflammatory foods there is so if you're going to eliminate a food, sugar should be the one.  That doesn't include fruit,  vegetables, or even raw honey but it does include anything with added sugar, processed foods, etc...

There are others that cause inflammation, as well, such as trans fats, refined carbohydrates (white flour, white rice, pasta, bread, etc), processed meats, alcohol, vegetable and seed oils, etc.

Inflammation has more to do with the microbiome than anything else so it's more important to eliminate the unhealty foods.  
“If one finds that they're sensitive to a food/food group, such as dairy or gluten, they should, by all means eliminate it or reduce consumption,”

“otherwise there's no real reason to do so as the science simply isn't available yet to prove that they cause problems for every one. “

So it’s ok to eliminate a food/food group if you’re sensitive to it, but just because science hasn’t proven that “they cause problems for everyone” then you should not eminate a food/food group that you are sensitive to? That doesn’t make any sense at all. Listen to your body and it’s response to foods, or listen to science because whatever it says or does not say yet is the golden rule?

There are links in my previous post and the references in those articles to studies on nightshades and the alkaloids in nightshades.
Thank you for all the info! I’m going to really watch what I eat and see which foods cause my neck pain to flare up!!  
Morning_Light... Perhaps you didn't read far enough in my comment, as I did go on to agree with you that "The suggested elmination (sic) diet is the best way to find out about sensitivities."
Barb135, yes,  I did see that. Science will never be able to prove that any certain food or food group is a problem for all or for everyone. If they did, that food would probably be removed from the food chain or would be labelled as a toxic substance or warning labels would be required about eating the food in excess, risks to pregnant women, or risks to people with certain health issues.

All we can do is be aware of studies on reactions certain foods or types of foods on certain health issues. Then, consider how those findings might be applied to our own health issues and our quality of life, and make decisions about our diets based on what is recommended for our health conditions or similar conditions (autoimmune disease, inflammatory conditions, thyroid disease recommendations).
649848 tn?1534633700
Qlane... awesome idea.  Even if you don't see an improvement in neck flare up, a good healthy diet will help the way you feel overall.

Because the microbiome is instrumental to inflammation, you might want to do some research into digestive enzymes and probiotics, which are both excellent ways to help improve the way we feel.
Thank you
Avatar universal
My tpo was 29, free t4 0.8. Told tpo elevated but not real high so  no treatment at this time . Just wanting input. The doctor I saw  I work for so I feel bad questioning him since he is the MD. I think further workup is needed though!?
Yes. If your TPO is elevated over the top of the lab range by any amount, this means that you have Hashimoto's. What is the lab range? You need complete thyroid tests, as previously said by several people. If you work for this MD and he thinks you are fine, all he tested was TSH, it is time to find a doctor who is knowledgeable about thyroid and Hashimoto's. The lab ranges are not included in your results, so we don't know what your results mean, plus they are incomplete tests. Not sure of the lab range of your FT4, but .8 on with the lab that I use is below the bottom number of the range and means very very hypo. If FT4 is this bad, FT3 is likely as bad because FT4 is converted into FT3. But, without knowing the lab range, 0.8 is just a number.
Here are the ranges. FT4 ( 0.76-4.78) mine 0.8, TPO (<9), mine 29, TSH (0.55-4.78), mine 3.33. So since the TSH and FT4 are in range he says no treatment needed at this time.  That’s all the labs he ordered after I requested thyroid workup. I’m going to find a different doctor for 2nd opinion or find Endocrinologist who can look at my labs and U/S.  I know something is off the way my body feels is which why I went to doctor in first place.  I told him I believe I have Hosimotos due to symptoms and heterogeneous U/S. Which he said U/S was normal.  Thank you for the feedback
649848 tn?1534633700
Although TPOab can be present in small amounts with other autoimmune conditions, the fact that yours is elevated most likely indicates Hashimoto's.  Was there a TgAb test done as well?  If not, there needs to be as both TPOab and TgAb are markers for Hashimoto's.  Either one or both can be the basis for a diagnosis.

What's the reference range for the Free T4?  I agree that 0.8 is at/near the bottom the ranges used by most labs and would indicate that you're hypo.   Without adequate Free T4, there won't be anything to be converted to Free T3 which is the hormone that's used by individual cells in the body.  

Most of us feel best with Free T4 at/about mid-range and Free T3 in the upper half to upper third of its range.  

I agree - if you can't ask questions of this doctor because you work with him, you need to find a different doctor to treat your illness.  This one will keep you ill because of lack of proper testing/treatment.

I agree and I agree that this doctor will keep you ill due to his lack of knowledge about thyroid testing and treatment. Asking questions of this doctor would be very frustrating, a waste of your time, and so far he looks to be very misleading. Further delay in diagnosis and treatment will only prolong your suffering and will keep you ill. Any doctor that only tests TSH and ignores over range TPO does not understand the thyroid gland or thyroid disease and really should not be trying to diagnose thyroid disease. He should focus on other health issues that he hopefully has the right knowledge for.
Thank you both for the feedback!
Avatar universal
Here are the ranges. FT4 ( 0.76-4.78) mine 0.8, TPO (<9), mine 29, TSH (0.55-4.78), mine 3.33. So since the TSH and FT4 are in range he says no treatment needed at this time.  That’s all the labs he ordered after I requested thyroid workup. I’m going to find a different doctor for 2nd opinion or find Endocrinologist who can look at my labs and U/S.  I know something is off the way my body feels is which why I went to doctor in first place.  I told him I believe I have Hosimotos due to symptoms and heterogeneous U/S. Which he said U/S was normal.  
Please check the reference range for the Free T4... that's a very wide range and it appears that you may have mixed up the upper level of the Free T4 with the upper level of the TSH since they're listed as the same value.  That said, your Free T4 is very close to the bottom of its range, which could very likely cause hypo symptoms.  Of course, without a Free T3, it's hard to say exactly what's going on, although, without adequate Free T4, it's unlikely to have adequate Free T3 either.

I agree that it's time to get a different doctor, but you don't really need an endocrinologist; you only need a doctor who will treat you by symptoms and not so much by the labs, particularly by the TSH, which I'd say is probably mostly what this doctor is looking at... If you can, look for one who leans more toward Functional or Naturopathic Medicine.  Some can be very expensive and don't take insurance, but there are some that function as primary care doctors and do take insurance.  

I did type range wrong FT4 (0.76-1.46) Thank you for the  information!
Thank you, that looks better... well, really it doesn't look good at all.  Your Free T4 looks pretty dismal at only 6% of its range, which is pretty much nothing.  Most of us feel best with Free T4 at/about mid-range and Free T3 in the upper half to upper third of its range.  You have a long way to go to even get your Free T4 to mid-range and of course, we have no idea about Free T3.  

If you can talk to your doctor, that's good, but if not, I wouldn't hesitate to find a different one.  The sooner you get treatment, the better.
Avatar universal
Please go to the library and get "Hashimoto's Protocol".  It literally saved my life! I have had 45 years of headaches/neck pain/trigger points etc. but was not diagnosed with Hashimoto's until March 5th, 2018!!! I suffered thru migraine surgery, 3 rhizotomies, acupuncture, 14 cortisone injections, 37 Botox injections, physical therapy, chiropractic, etc. I have taken 800 Ibuprofen in the last FIVE years!! Along with naproxen sodium, butalbital, oxycodone, hydrocodone, Inderal, midrin, ergotamine, rexall, amitriptyline, imitrex, etc etc. I should have killed myself long ago. GET THIS BOOK! [i am headache-free and 16 lobs lighter!]
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