Thyroid UK
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Thyroid pain only afternoon

My significant other has thyroid/front of neck pain only in the afternoons, coincides with difficulty concentrating. We both suspect he has Hashimoto's, with possible B12 deficiency (given the slightly elevated ALT). His doctor has agreed to test TPO antibodies soon, and also referred him to an ENT. I think the ENT is a waste of time given his results. What do you guys think? Has anyone experienced the afternoon only thyroid pain? My theory is perhaps his T4 synthesis peaks in the afternoon with corresponding peak of TPO and thyroglobulin expression, hence having pain only in the afternoons.


Ultrasound - perfectly normal, no inflammation, no nodules

TSH 4.3 mIU/l (range 0.3- 3.18)

Free T4 18.2 pmol/l (range 13.1-21.3)


Serum total protein 72 g/l (range 64-83)

Serum bilirubin 13 umol/l (range <21)

Serum ALT 46 IU/l (range 62-106)

6 Replies

Sorry, ALT range is <41



Is your partner prescribed Levothyroxine as his TSH is high?

Hashimoto's is usually diagnosed when thyroid peroxidase or thyroglobulin antibodies are over range. Ask his GP whether either were tested. He should have B12 and folate blood tests if B12 deficiency is suspected.


He was not prescribed T4, even getting the TPO test approved was like pulling teeth with this doctor. I do know how Hashimoto's is diagnosed since I was diagnosed only 2 months ago. I'm helping my partner with the science (I'm a scientist) of the disease. My main question is: am I on the right track, thinking he's got Hashimoto's (and B12 deficiency) too, or is a different diagnosis more likely, if so which one? He was not given B12 and folate tests so we probably will have to go private for those.



If your partner is symptomatic he should ask for a trial of Levothyroxine as his TSH is over range.

90% of hypothyrodism is caused by Hashimoto's so it is likely your partner has it. What was his TPOab result and range?

If TPOab is negative it is worth ordering a private thyroglobulin antibody test because many people are negative for TPOab but positive for TgAb. Blue Horizon Thyroid Plus 11 includes antibodies and some vitamin and mineral tests.

There's no point in guessing whether or not your partner has B12 deficiency. If he is symptomatic ask his GP to do a B12 and folate blood test. B12 and folate are included in the Thyroid Plus 11 test above.


He has not had the TPO antibody test yet, this is in 2 weeks. The GP he spoke with was very unhelpful and was dead set on sending him to an ENT, disregarding all his thyroid complaints and TSH results thus far "because the T4 was normal". She clearly does not know that it can swing from one end to the other when having Hashimoto's. And, rather disturbingly, she didn't care about the liver enzyme being elevated either. I'd say there's about 5% chance she might agree to a T4 prescription trial but I think my partner would rather wait just a little longer and have a concrete diagnosis first.

Thank you for the Blue Horizon suggestion, I think we will do this for speed and convenience. My partner wants to see an endocrinologist privately once we have these results. And thank you for all your help, it seems we are all in agreement on my partner's (provisional) diagnosis. I will post again once he's done more blood tests.



When TSH is over range but <10 with FT4 in normal range it is called subclinical hypothyroidism. Many GPs treat subclinically hypothyroid patients with Levothyroxine, especially when TPOab are positive, to slow progression to overt hypothyroidism which is when TSH is >10. There remain some sadistic doctors who will not make a diagnosis until TSH is >10.

Email for a list of member recommended endocrinologists.


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