Barium Swallow

[phoenixpippa]

Hi, I have recently had a scan on my neck and nodules have been found on my thyroid. I am experiencing many symptoms suggesting a thyroid problem despite blood test results being in normal range. Now the doctor wants me to have a Barium Swallow test to find out why I am having trouble swallowing. It is obvious its a nodule causing the problem pressing on the tube. Has anyone else had to have a Barium Swallow? I really need help please as I am sure this is not a normal route. Also does the Barium contain dairy or gluten?

[Jaydee1507 Administrator]

Welcome to the group.

Do you have copies of your thyroid results? Ask GP receptionist to print them for you, you are legally entitled to this.

Have you had your thyroid antibodies tested?

In the early stages of thyroid disease we can suffer from many symptoms despite 'normal' results. Doctors do not understand this and will always be happy to look elsewhere. I did have a barium swallow years ago, not very nice. I'm not sure what the preparation contains.

[phoenixpippa in reply to Jaydee1507]

Hi, They did the TSH 1.89 mU/L and T4 11.8 pmol/L.

[Jaydee1507 Administrator in reply to phoenixpippa]

What time of day was that test? It's recommended to get tested at 9am or as close as possible as this is when TSH is at it's highest.

Do you have the reference ranges for those tests? They vary from lab to lab so are important to quote - numbers in brackets after your test result number.

Your FT4 does look on the low side.

Have you had your thyroid antibodies tested? Can be useful if positive to indicate an autoimmune throid issue.

[phoenixpippa in reply to Jaydee1507]

It was at 9.45am. TSH range is 0.35 - 5.5 and T4 range is 10.5 - 21.0.

[Jaydee1507 Administrator in reply to phoenixpippa]

So your FT4 is only at 12% of it's range which is pretty low. Would expect it to be above 50%.

NHS only tests minimal thyroid levels. There's also FT3 which is the active hormone and including this gives a fuller picture of whats happening. members of this group pay for private tests to see the full thyroid panel to include FT3. Thyroid UK have discount codes for some of them.

thyroiduk.org/help-and-supp...

What's happening about the nodules/scan?

[phoenixpippa in reply to Jaydee1507]

I spoke to the doctor this morning as she said blood test normal so no action and she did not want to do anything about the scan until we had a few words of disagreement and I told her again I am having trouble swallowing liquid. I now have an appointment with ENT at hospital tomorrow with a consultant. I presume that was because she requested a barium swallow test. I kept saying the problem is caused by pressure on the outside not in the throat.

[Jaydee1507 Administrator in reply to phoenixpippa]

Let us know how that goes then and good luck.

When you get your thyroid tested always do that at 9am or as close as possible, fasting. It is when TSH is highest.

[phoenixpippa in reply to Jaydee1507]

Up date on seeing ENT consultant. He had no interest in looking at the list of symptoms I wrote down and only glanced at it for a couple of seconds. He felt my throat pushing quite hard that hurt. Then squirted numbing solution up my nostrils and put a camera up to see my voice box and tube for food. On showing me the picture on a screen he said my voice box was in lovely condition. ( I never said I had any problem with that). My food pipe has a slight swelling but he said not enough for it to be a thyroid nodule and must be aggravated by silent acid reflux. Then prescribed Gaviscon liquid 10ml 4 times a day. I said what about the other symptoms and was told he knows what he is talking about as he is trained to deal with thyroid problems and to go back to the doctor. I was not nervous of going there but started having countless bad panic attacks before the appointment and still am. The numbing solution played havoc in my sinuses and I was in so much pain one side of my face and head for more than a day. I feel so tired and slept most of yesterday. I really don't know where I go from here and do not have any money to go to see a private specialist.

[Jaydee1507 Administrator in reply to phoenixpippa]

Anxiety issues can be due to low levels of B vitamins. Remind me if you've had ferritin, folate, B12 & D3 checked lately and what were the results?

Intolerance of gluten and dairy can be due to MTHFR gene which means your body doesn't use folate and sometimes B12 well. Your GP won't understand what that means though.

[phoenixpippa in reply to Jaydee1507]

My Ferritin was Serum C reactive protein level <4 mg/L (0.0 - 9.0) Serum calcium level 2.30 mmol/L (2.8 - 2.65), Serum albumin level 34g/L (35.0 - 50.0), Serum adjusted calcium concentration 2.43 mmol/L (2.2 - 2.6). There was no test for B12 or D3.

[Jaydee1507 Administrator in reply to phoenixpippa]

So it would be a good idea to get tested for folate, B12, D3. What was the ferritin result?

Private tests are available if your GP won't do them.

thyroiduk.org/help-and-supp...

[phoenixpippa in reply to Jaydee1507]

My Ferritin was Serum C reactive protein level <4 mg/L (0.0 - 9.0). I do not have the funds for anything private. I wish I did as I would probably get a better result.

[Jaydee1507 Administrator in reply to phoenixpippa]

There should be a number next to your ferritin result. It's nothing to do with Serum C reactive protein.

If you have a lot of fatigue then sometimes if you find a helpful GP at your practice they will run the vitamin tests.

[phoenixpippa in reply to Jaydee1507]

Is this the right one? Serum ferritin level 59.3 ug/L (10.0 - 291.0)

[helvella Administrator]

I've had a barium swallow.

It was not exactly how I'd choose to spend time, but it wasn't distressing, uncomfortable, etc.

Any swallowing issue is likely to be investigated by a barium swallow as it allows looking at the throat in action. Most other ways of looking are static - e.g. an ordinary MRI. Therefore they can see things which are not obvious by other techniques.

[SlowDragon Administrator]

Welcome to the forum

What blood tests has GP done

Far too often they only test TSH and Ft4

For full Thyroid evaluation you need TSH, FT4 and FT3 tested 

Also both TPO and TG thyroid antibodies tested at least once 

Very important to test vitamin D, folate, ferritin and B12

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

Sounds like your scan has already found the issue

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

[phoenixpippa in reply to SlowDragon]

Hi, Only tested for TSH 1.89 mU/L and T4 11.8 pmol/L. The other tests were crp, lipid profile,liver function,electrolytes,calcium,full blood count,erythocyte sedimentation rate,ferritin. In the past I have had results for folic acid and vitamin D that both needed a course of medication for.

[SlowDragon Administrator in reply to phoenixpippa]

Ft4 looks low

what’s the range on Ft4 (figures in brackets after the result)

What time of day was test done

What was ferritin result

Vitamin D and folate and B12 need retesting

What vitamin supplements are you currently taking

[phoenixpippa in reply to SlowDragon]

It was at 9.45am. TSH range is 0.35 - 5.5 and T4 range is 10.5 - 21.0. Ferritin result was Serum C reactive protein level <4 mg/L (0.0 - 9.0). I dont take anything in the way of vitamins at present. I am currently taking Fluoxetine oral solution and Pantoprazole tablets. I am unable to take anything with dairy or gluten which started a few years ago.

[SlowDragon Administrator in reply to phoenixpippa]

Ferritin range is usually 13-150

Are you sure that’s correct results you have there

Gluten and dairy intolerance are EXTREMELY common with autoimmune thyroid disease (hashimoto’s)

ncbi.nlm.nih.gov/pmc/articl...

In contrast, clinically silent SSRI-induced abnormalities in thyroid function tests have been widely documented.2,10 After paroxetine treatment in severely depressed patients, for example, T4 level has been reported to decrease by 11.2%. Fluoxetine has been reported to reduce T3and T4 levels in otherwise euthyroid depressed patients.11 Similarly, sertraline and fluoxetine have been reported to reduce hypothalamic thyrotropin-releasing hormone secretion, which would reduce secretion of TSH from the pituitary gland and thyroid hormones from the thyroid.12

How long have you been on Pantoprazole

Pantoprazole is a PPI - Proton Pump inhibitor. This lowers stomach acid.

Low stomach acid leads to low vitamin levels

Low stomach acid can be a common hypothyroid issue

There’s Thousands of posts on here about low stomach acid 

healthunlocked.com/search/p...

Web links re low stomach acid and reflux and hypothyroidism 

nutritionjersey.com/high-or...

stopthethyroidmadness.com/s...

thyroidpharmacist.com/artic...

 How to test your stomach acid levels 

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

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

But never assume you have low stomach acid 

healthygut.com/4-common-bet...

Ppi 

Like Pantoprazole Or Omeprazole will lower vitamin levels even further 

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

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes 

gut.bmj.com/content/early/2...

Iron Deficiency and PPI 

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

[phoenixpippa in reply to SlowDragon]

Yes the numbers are correct. I printed them off and just checked again. I have been on PPI medication for many years but Fluoxetine for about a couple of years. I suffer with bad panic attacks and general anxiety. I am in a terrible state each time I have tried to stop and end up back on them. I think the longest break was 1 to 2 years. So are you saying the medication has caused a thyroid problem?

[SlowDragon Administrator in reply to phoenixpippa]

probably the other way around

Being hypothyroid causes depression and anxiety and panic attacks …..And Low stomach acid

Low stomach acid frequently misdiagnosed as high stomach acid and left on PPI

Long term PPI use leads to serious vitamin deficiencies, especially magnesium, B12 and iron/ferritin

[phoenixpippa in reply to SlowDragon]

Oh thank you. Strange question but if I get excited I get the same symptom reactions as I do with a panic attack. For example nausea, upset stomach, palpitations etc. Would this be due to the thyroid?

[SlowDragon Administrator in reply to phoenixpippa]

yes quite possibly

[SlowDragon Administrator in reply to phoenixpippa]

How low was vitamin D before starting vitamin D supplements

How long did you take vitamin D

Levels should have been retested…were they

You should have been advised to continue supplementing indefinitely…..retesting twice year

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

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

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, (but must be four hours away from levothyroxine )

Gluten free diet is low in magnesium

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[phoenixpippa in reply to SlowDragon]

The vitamin D courses were both different. The first was a few weeks on a tablet prescribed by a doctor for a short high dose. The second I was told to get over the counter and take for a couple of months. Neither were tested after. My last test was about a year ago and levels were normal. I did try another course of over the counter since because of feeling tired but the tablets made me feel nauseous so I stopped them and assumed as that blood test showed good levels it was because I was putting too much in. That would have been a few months before the last blood test for vitamin D.

[tattybogle]

if we compare your results to the picture below of "10 healthy people with no thyroid problems" ,

your TSH: 1.89 (Range 0.35 - 5.5) 29 %

your FT4: 11.8 (Range 10.5 - 21) 12 %

you can see that your pairing of TSH and fT4 levels closely match person 3 and 6 ~they have fT4 at about 12 % too .... so without more evidence (eg an fT3 result that was at an unexpected level ), your lowish fT4 level in itself is not evidence that there is anything wrong with your thyroids ability to make enough thyroid hormone .

This is why the GP is unlikely to see any problem with your thyroid function from looking your TSH / fT4 result , even though your fT4 is a bit lower than some other people.

If an fT4 of 12% was 'too low for you' (eg if it was usually 60% when you were healthy and it's only 12% because your thyroid was struggling ) , then you would expect your TSH to have gone higher to 'ask' your thyroid to try and make more T4 .

eg. If person 9 whose fT4 is usually 60% developd a thyroid problem and it was only able to make 12 % ~ then you would expect their TSH to rise from where it is on this chart to 'ask' their thyroid to try to make 60% again ....they would not have a 'comfortable' TSH of around 25% anymore , it would probably have gone over-range .

GP's do make the assumption that your pituitary is able to make more TSH if your fT4 is 'too low for you' , but that assumption isn't always correct ... and they don't measure fT3 .. so they don't get the full picture .. which is why it is important they take your symptoms into proper consideration and don't fob you off just because your TSH /fT4 results 'look' normal .

.

[phoenixpippa in reply to tattybogle]

Thank you. Very informative.