Lump sensation - can't detect from physical examination of throat, but could it still be thyroid nodules?

[Trigger1]

I've had a lump sensation in my throat for over 3 months now, which the doctor keeps telling me is most likely due to sinus problems etc. I suppose this is possible, although it doesn't feel like it to me. It isn't possible to feel the lump by externally examining my throat. Has anyone ever subsequently been diagnosed as having thyroid nodules or lumps after an ultrasound that weren't obvious from a physical examination of the throat? My doctor is refusing to refer me for an ultrasound and I'm just not comfortable ignoring a lump in my throat on the basis of a probability.

I have not been diagnosed with a thyroid condition as yet, but latest tests show - TSH 5.22 (0.27 - 4.2)

fT4 15.1 (12.0 – 22.0) fT3 5.3 (3.1 – 6.8), Thyroglobulin Antibody 19.2 (0 - 115) and Thyroid Peroxidase Antibodies 7.9 (0 – 34).

I have made a separate post with all my results which Grey Goose has very kindly advised looks like I may be in the process of developing Hashis - but I just wondered about the lump and if I should be pushing for an ultrasound, or waiting to see if the lump becomes more obvious?

[Clutter]

Trigger, I think it is more likely that your thyroid gland is swollen because the TSH is flogging it very hard to pump out the thyroid hormone you need. Your antibody results are negative for Hashimoto's now but it is worth retesting them in a year or so in case it develops.

I don't understand why your GP hasn't prescribed a trial of Levothyroxine. I think this would successfully lower your TSH, improve your FT4 and FT3 and take the pressure off your thyroid gland. Your FT4 is lowish in range which will make it difficult to convert sufficient T3 although your FT3 isn't currently too bad. TSH becomes elevated in response to low circulating hormone.

Your GP isn't being entirely straight with you either. GPs can order ultrasound scans and often do before making referrals to an endo.

I think I would be seeking a second opinion as to diagnosis and treatment from another GP at your practice.

thyroiduk.org.uk/tuk/diagno...

Scroll down to Guidelines and Treatment Options to read Dr. A. Toft's comments in Pulse Magazine thyroiduk.org.uk/tuk/about_...

If you want a copy of the article to show your GP email [e-mail]

[Trigger1 in reply to Clutter]

Thank you Clutter - this is incredibly helpful and I have just read all the information in your two links. My GP is very friendly and approachable and also seems open to the fact that testing TSH alone is not enough to diagnose - however, she was not going to consider a possible diagnosis of Subclinical hypothyroidism - probably because the Thyroglobulin antibody test was listed as negative and the Peroxidase antibodies were low in range. I am open to changing my GP - but I think she is probably the best of a bad bunch in my experience - she is at least happy to print my blood test results out for me - which is more than most will do!!

You comments make a lot of sense though and I am sensing that you think it would not be beneficial to push for an ultrasound at this stage, if it is likely to just be an enlarged thyroid, which I didn't know could happen. It is strange because I would say the lump is more noticeable in the evenings - not sure why that could be.

I am thinking I will leave it a couple of months and pay for another Blue Horizon test to see if anything has changed. It's a difficult decision to make though, because part of me thinks it would be easier for me if I had an official diagnosis before commencing treatment, but the other part of me is reluctant to let this do any more damage to me in the process. Thank you so much for your advice though and everyone on here - everyone seems so clued up on this. It's just staggering that the people who have spent years and years training as doctors can't get their heads around it.

[Clutter in reply to Trigger1]

Trigger, if the gland is swollen because it is working too hard it should go down on 50mcg-75mcg Levothyroxine. It may be worth asking for a 3 month trial. Hashimoto's isn't the only reason for hypothyrodism although it is the most common. 10% of hypothyroid patients don't have Hashi's.

[Trigger1 in reply to Clutter]

Oh I see - sorry yes I did read that in your links. I'm just thinking Hashimoto's because it's so rife in my family - but yes I see what you're saying.

[Clutter in reply to Trigger1]

Trigger, just bear in mind it may be brewing but Levothyroxine at this stage, rather than waiting until you are overtly hypothyroid with TSH >10, may nip it in the bud.

[Trigger1 in reply to Clutter]

Thank you Clutter. I think I have a lot to think about. I know my GP (and most likely any GP in my practice) wouldn't consider treating me based on those results, so this decision means me self-treating, which I am prepared to do, but I need to give it some thought. I'm still thinking it might be a good idea to spend a couple of months getting my vitamin levels good, so that I am in the best position for any thyroxin to work - I wonder how well it would work if I started thyroxin now with low b12, vit D and ferritin. But on the other hand - I completely understand what you're saying - nip it in the bud and I'm so much luckier than many others to have 'advance warning' and the chance to stop it in its tracks. Gosh I don't know what to do. I do appreciate your advice though and the information - you have all be so helpful and I'm taking on board everything you all say. I intend to be proactive.

[Clutter in reply to Trigger1]

Trigger, Thyroxine now will still work even when vits/mins are low. It will work better when vits/mins are good. This isn't an attempt to push you into self-medicating. If you are able to wait you might get a diagnosis and a few months longer isn't likely to make a lot of difference.

[Trigger1 in reply to Clutter]

Hi Clutter - oh I know you aren't pressuring me - it is good to have all the information so that I can make an informed decision. I am absolutely listening to all your advice and will give it a lot of thought. If I hadn't asked on this forum, I would still be none the wiser and following my GP's advice, which is essentially to do nothing and wait until I'm so ill I can't function and possibly irreversible damage is caused. So I'm incredibly grateful.

[TheLadyOfShalott]

Hi Trigger. I am in the process of trying to obtain a thyroid ultrasound scan from my GP. I've told him I'll even pay for it myself if only he'll make the referral. F**king drs; I hate the whole lot of them. Thyroid ultrasounds can detect nodules as small as 2mm - which a dr obviously can't just on feeling the neck. So I'd trust an ultrasound over a physical exam. My dr (lower case on purpose!) hasn't even felt my neck. They're all a bunch of crummy bas**ds if you ask me. It even states on the NHS website that all blood tests for thyroid can come back completely normal when there is thyroid cancer. Your health is never something to gamble and preventative health is the way forward. Better to check and be safe than sorry later on! If Lynda Bellingham taught us anything, it was to always get things checked out!