Anyone experienced lump like feeling in thyroid area

[Flashgirl]

Hello all. I would really love to hear from other people who have experienced a lump like pain in their thyroid... how you managed it, who you saw, what it was and hopefully how you made it go.

I was diagnosed with Hashimotos in jan 2020. I’m on levo 75 but not really improving yet (fatigue etc). Speaking to endo Tuesday so hopefully he can adjust my meds.

Since diagnosis in Jan I have a lump pain in my throat as if I’m being strangled. Scan in March showed some “vascularity” (thyroiditis) but no nodules or goiter.

Endo prescribed two courses of prednisolone for inflammation (a weaker one and then a strong one starting at 40mcg). Because the prednisolone didn’t work, my Endo doesn’t feel this is a thyroid issue and says I need referring to ENT. Because of covid I can’t have endoscopy as I can’t self isolate (young family). Had barium swallow and MRI and thankfully nothing sinister.

GP put me on PPIs (for 10 weeks now) as thought could be silent reflux - again no improvement. Tried acid watcher diet and not worked ... also have gone gluten free just incase. Will try anything!

It’s a horrible pain. Almost like being strangled and lump stuck in throat. Also the area is very tender love when I touch it. No coughing and no pain when I eat. Could it even be that once my thyroid is working at its optimum It may go? So frustrating!!!

FYI test results below

thanks all!

SERUM TSH

JAN 2020 - 1.75mu/L (0.35-5.00mu/L)

MAR 2020 - 1.51mu/L (0.35-5.00mu/L)

APRIL 2020 - 0.66mu/L (0.35-5.00mu/L)

JULY 2020 - 0.41mu/L (0.35-5.00mu/L)

SERUM FREE T3

MAY 2020 - 3.80pmol/L (2.60-5.70pmol/L)

JULY 2020 - 4.6pmol/L (2.60-5.70pmol/L)

SERUM FREE T4

JAN 2020 - 9.7 pmol/L (9.00-22.0pmol/L)

MAR 2020 - 11.1 pmol/L (range 9-22.00pmol/l)

APRIL 2020 - 13.3 pmol/L (range 9-22.00pmol)

JULY 2020 - 11.7pmol/L (range 9-22.00pmol/l)

[SlowDragon Administrator]

Previous post shows you are under medicated and need dose increase in levothyroxine

healthunlocked.com/thyroidu...

Most Hashimoto’s patients have LOW stomach acid

PPI is used to treat high stomach acid and will lower vitamins even further

nutritionjersey.com/high-or...

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

healthygut.com/articles/3-t...

naturalendocrinesolutions.c...

Ppi

pulsetoday.co.uk/clinical/m...

gov.uk/drug-safety-update/p...

Thousands of posts on here about low stomach acid

healthunlocked.com/search/p...

[SlowDragon Administrator]

Also ....guidelines by weight might help push GP for next dose increase

Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Flashgirl in reply to SlowDragon]

Hi. Thanks for this will look through the links. Just wondered in your experience of this board, if this is normal to have this pain? I can’t really find any links on the internet! It’s frustrating as I feel I should stop the PPI but my doctor wonders if the pain is reflux so that’s why she has put me on them! I just want it to go.

[SlowDragon Administrator in reply to Flashgirl]

Yes pain and difficulty swallowing are common hypothyroid symptoms especially if your autoimmune thyroid disease (hashimoto’s) is resulting in Ord’s thyroiditis where thyroid shrinks and shrivels up into hard lump

Medics often think “lump in throat” is almost exclusively due to “anxiety “

Your low Ft4 suggests you are ready for next dose increase in levothyroxine

Do you always get same brand of levothyroxine?

[Flashgirl in reply to SlowDragon]

Thanks for coming back to me so rapidly and being helpful!!

Yes. The word globus sensation was mentioned to me. 🙄 Which is anxiety based. My levo is a combination of 50 accord and 25 teva. Does it make a difference what brand it is?

I’m hoping my Endo puts me up Tuesday as my ft4 dipped Since upping to 75. Is my tsh low in your opinion? What does this mean. When I google it’s hard finding info on low tsh and low ft4. (I assume it’s low?!?). 😊

[SlowDragon Administrator in reply to Flashgirl]

Teva is a Marmite brand....some love it, many hate it

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Teva and Aristo are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

[SlowDragon Administrator]

Could it even be that once my thyroid is working at its optimum It may go?

Your thyroid isn’t going to start working again ...but once you are on adequate dose of levothyroxine you should find pain and lump subsides

You may, like many Hashimoto’s patients, need small dose of T3 alongside levothyroxine

But first step is to get dose increased slowly upwards until on full replacement dose

[Flashgirl in reply to SlowDragon]

Interesting. My t3 seems high in the range. Don’t really know a lot about t3 though. Also I’m having terrible hot flushes at the moment. I know it’s muggy but they are noticeable (I’m 46 so may be perimenopausal but dont think it’s this - suppose that’s another thing to throw into the mix 😳. To be a woman!!)

[SlowDragon Administrator in reply to Flashgirl]

Early stage Hashimoto’s, levels can hop about a lot

Hot flushes at night can be low B12

[Flashgirl in reply to SlowDragon]

Ah. My b12 is right at the top of the range. Will mention to my Endo next week. Thanks.

[SlowDragon Administrator in reply to Flashgirl]

Are you supplementing B12?

Or vitamin B complex?

[Flashgirl in reply to SlowDragon]

Yes the better you b12. methylcobalamin?

[Simonron]

I have a 3.5 cm enlargement on the 'rhs' ie on the left of the neck. It shows up in a PET scan on the right hand side of the image - it took me some time to work that out ! I can feel a pressure on the left of my neck, not painful, but it gets disturbing when I think of it. So, I shall stop

[Flashgirl in reply to Simonron]

Ha! Yes I’m like this!! When I try not to think about it I then think about it. Had an MRI showing nothing notable. The scan showed vascularity (I think this was the word they used!)

[Uze40]

I have started getting this pain in my thyroid I have been managing it through Qi gong so far as I haven't had any clear diagnosis (yet). My thyroid has enlarged but my readings are normal. I have been tracking pain and its definitely stress related for me. My thyroid isn't tender I can feel it hurting now as I write about this. You must be please it's nothing sinister however it's just so stressful not knowing what is causing it. I will be interested to see what ENT say as I teach and wonder if that has played a part.