Worried - painful thyroid gland for no apparent reason

[cat_alli]

I'm 55 and have been diagnosed with Hashimoto's since 2010. For the first time ever my thyroid gland has been painful, sore all over and very sore in one particular place about the size of a 1p piece. I had no symptoms of being unwell, I just woke up one morning and the gland was sore, the next day the pain was at its worst, and after four/five days it is now going back to normal. It was not due to sleeping at an uncomfortable angle, or any trauma like straining my neck or whiplash.

I don't know whether I should be worried about this. Should I go to my GP and if so, should I be asking for a particular treatment or scan? Thank you.

[SlowDragon Administrator]

First step is to get full Thyroid and vitamin testing

Come back with new post once you get results and ranges

Are you still on 100mcg Levothyroxine

Had any change in brand of Levothyroxine?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Ask GP for ultrasound scan of thyroid if pain persists

[cat_alli in reply to SlowDragon]

Thank you SlowDragon. My Blue Horizon fasting results last month were:

HbA1c-(iFCC) 37 (20 - 42) nmol/mol

hs-CRP 2.10 (<5.0) mg/L

Ferritin 90.1 (13 - 150) ug/L

Magnesium 0.98 (0.7 - 1.0) nmol/L

Insulin 33.8 (<173 fasting) pmol/L

TSH <0.005 (0.27 - 4.20) mIU/L

T4 Total 87.8 (66 - 181) nmol/L

Free T4 20.20 (12.0 - 22.0) pmol/L

Free T3 4.72 (3.1 - 6.8) pmol/L

Reverse T3 23.0 (10 - 24) ng/dL

Reverse T3 ratio 13.36 (Normal >15, Borderline 12 - 15, Low <12)

Anti-thyroidperoxidase abs 291.0 (<34) kIU/L

Anti-thyroglobulin abs 21 (<115) kIU/L

Vitamin D (25 OH) 57 (Deficient <30, Insuffcient 30 - 50, Consider reducing dose >175) nmol/L

Vitamin B12 277 (Deficient <145, Insufficient 145 - 300, Consider reducing dose >569)

Serum Folate 28.7 (8.83 - 60.8) nmol/L

I don't actually know what the first two tests in this list are. The blood was drawn at 9am and that was 24 hours after my last tablet. I'm still on 100mcg Levothyroxine and the brand hasn't changed, at least I think the boxes look the same.

I'm also on a low level of oestrogen + progesterone HRT.

Do you think I need to get further tests done, despite the above tests being just a month ago? I paid for the comprehensive Blue Horizons tests because I had a horrible spell of depression last Oct/Nov/Dec. I cancelled everything in my diary and concentrated on feeling better in my head, and since February till now I have been feeling very thankfully fine.

The pain is still in my thyroid gland but it feels more like a residual bruise deep inside when I feel for it, rather than the very noticeable pain I had a few days ago when just moving my head made me conscious of it.

[SlowDragon Administrator in reply to cat_alli]

B12 and folate on the low side. Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

I prefer Igennus Super B complex. Nice small tablets. Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low vitamin D and low B vitamins may be linked as explained here

healthunlocked.com/thyroidu...

Vitamin D is too low.

GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Retesting twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average

Local CCG guidelines

clinox.info/clinical-suppor...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Are you on strictly gluten free diet? Or tried it ?

HRT frequently results in needing higher dose of Levothyroxine

Suggest you improve vitamin levels and retest thyroid and vitamins in 2-3 months

[cat_alli in reply to SlowDragon]

Thank you for all your amazing advice. I follow a strict gluten free diet and am also allergic to cow dairy (not goat or sheep dairy), egg, yeast and Brazil nuts.

I will start supplementing with the Igennus Super B complex. Due to the yeast allergy I stopped eating the gluten free version of Marmite, which may have contributed to the low result.

I was already supplementing for vitamin D with liquid Nutri Advanced Vitamin D with K2 3000iu daily, so am disappointed my result is so low. I will change to the mouth spray you recommend. I definitely have poor gut function due to years of high antibiotic use compounded with appendicitis last year where the hospital had to flood my system with intravenous antibiotics. I'm working with a nutritionist to improve my gut health, but it's taking a long time.

I will discuss with my GP about the HRT and my Levothyroxine dosage level. As I (at the moment) feel fine with my energy level I was thinking I was on the right dose, although that level of 100mcg daily was the dosage for a couple of years before I started the HRT last December. I don't think my GP will agree to increase the dosage level however, given my TSH level of 0.005.

[Lalatoot]

I get a sore thyroid and my voice goes croaky and disappears. This happens when I am undermedicated and have run out of steam. As SlowDragon suggests I would get your levels checked in the first instance.

[cat_alli in reply to Lalatoot]

Thanks for the advice.