Autoimmune thyroiditis with lump in throat as first symptom and normal thyroid levels - medication necessary?

[Bookminhoca]

I was diagnosed with autoimmune thyroiditis last month after a neck and thyroid ultrasound. I went to the doctor initially as have had a constant lump in my throat since June andbwas worried about throat cancer (I am 44 and haven't smoked since my early 20s but my dad had throat cancer). This hasn't been ruled out as the ultrasound technician told me this scan can't see throat tissue but looking online, I am wondering if it is related to my thyroid. Has anyone had a similar initial symptom?

I now have more symptoms (throat tightness and discomfort that radiates to my ears, tingling in hands and feet, lack of sensation in my skin and difficulty concentrating).

I got my blood test results last week and have a doctor's appointment soon and want to arm myself with as much information as possible beforehand. I am currently not on any medication. My thyroid results seem normal but I have low b12, ferritin, iron and folic acid. Should my doctor prescribe thyroid medication if the levels are ok or just deal with the deficiencies? I really want to resolve my throat issues as I am very uncomfortable. Here are my levels with ranges in brackets:

TSH: 2.29 (0.55-4.78)

FT4: 12.9 (11.5-22.7)

T3: 1.68 (0.92-2.79)

Anti thyroglobulin: 3.2 (<4.5)

PTH: 27.4 (15.0-65.0)

TPO: <28.0 (<60.0)

B12: 137 ng/l (211-911)

Folate: 4.7ng/ml (>5.4)

Vitamin D: 26.7 ng/ml (<20 deficient, 20-30 insufficient)

Iron: 49 ug/dl (50-170)

Ferritin: 13.8ug/l (10.0-291.0)

Any advice much appreciated. Finding this message board has been really helpful so thanks to all who have shared links and information.

[PurpleNails Administrator]

Welcome to forum,

Can you add ranges, ranges vary between labs so always needed to interpret accurately.

Was FT3 (free t3) tested or is that Total T3, as FT3 is a useful measure to know.

You also need TPO antibodies tested.

Dr is obligated to offer supplement for nutrient deficiencies. However it is not always at a sufficient dose to improve the deficiency & doctors do not always offer to monitor.

If in range it is considered acceptable, but often being just in range is far from being optimal, eg in top 50% of range, but you’re good to go because you’re at 5%.

Obtain an actual copy of scan report, don’t rely on what doctors understand & decide to explain / inform you of.

📕 🐛

[Bookminhoca in reply to PurpleNails]

Thanks for your advice. In Portugal they give the patient the scan and test results for you to pass from doctor to doctor so I have all the documents. I'll try to upload blood results now. TPO was 28.0ul/ml

[Bookminhoca in reply to PurpleNails]

Ranges added. Thanks!

[SlowDragon Administrator]

Welcome to the forum

Please add ranges (figures in brackets after each result)

Different labs have different ranges

Are you based outside U.K.?

If yes please add country of residence on your profile

Was test done early morning, ideally around 9am

No TPO antibodies test?

[Bookminhoca in reply to SlowDragon]

Thanks for replying so quickly! I'm british but I live in Portugal so I'm not sure if results are presented in the same way. I'll attach photos.

Yes, the test wax done at 8am on an empty stomach.

[Bookminhoca in reply to SlowDragon]

Ranges added. Thanks.

[greygoose]

Hi Bookminhoca, welcome to the forum.

Is this lump visible in your neck? Or is it just a feeling you have in your throat?

Could be that your thyroid is swollen and pressing on the oesophagus making swallowing difficult. I had that long before I was diagnosed. The ENT put a tube up my nose and down my throat (ugh!) and announced that there was absolutely nothing wrong with me! Well, there was, I had Hashi's, but he didn't seem to know that the thyroid is just the other side of the oesophagus wall and can exert pressure on it.

I also had other throat symptoms: a continuous dry cough from my throat (not the lungs), losing my voice - sometimes midsentend! Sore throat, change in voice, difficulty swallowing, etc. But he just dismissed all of these. And all the time it was my thyroid! Who'd a thunk it! Obviously not him. Sigh.

Can't comment on your lab results without ranges, but it doesn't matter that you're in Portugal. Once we have the ranges we can work out the percentages and know if your results are high or low. Although, for the TSH, we don't need a range because a TSH is always a TSH and the range is just for show. And your TSH says that your thyroid is probably struggling, although probably not hypo yet.

[Bookminhoca in reply to greygoose]

Hello greygoose. Thanks for sharing your experiences. Ive added the ranges.

It's the sensation of a lump. Nothing visible and both scans showed nothing to explain it specifically but did refer to micronodules on the thyroid. I can swallow fine and in fact eating is the only time the sensation goes away. That and for about 5minutes when I wake up in he morning. I honestly thought I had stress related globus but seems too much of a coincidence that my thyroid is inflamed.

I don't know whether to push for an endoscopy to rule out a lump or a CT scan. I did read that ultrasound isn't good at identifying nodules behind the thyroid.

[greygoose in reply to Bookminhoca]

No, I don't think it is. And I don't think an ultrasound would acheive much at this point. It won't get you any sort of diagnosis at this point. Your TSH is too high, showing that your thyroid is struggling, and your FT4 is low. But your FT3 is OK at the moment, thanks to the higher TSH. But, that probaby won't last, and your FT3 will probably drop at some point.

Your antibodies are negative but that doesn't mean you don't have Hashi's. Antibodies fluctuate so could go higher at any time. Also, not all Hashi's people ever have raised antibodies. So, you could still have it. Time will tell.

[Bookminhoca in reply to greygoose]

Thanks again. Do you think I should be on medication with these levels or just repeat test in a few months to monitor levels?

[greygoose in reply to Bookminhoca]

In an ideal world you would probably benefit from some thyroid hormone replacement, but in this world, you'd never get a doctor to give it to you because everything is 'in-range'. And they don't know any better than that!

[LilacandMint]

PTH is high which usually happens when you have hyperparathyroidism. Please ask for a repeat test that includes calcium, vitamin D, phosphate and PTH from the same blood draw. These will diagnose hyperparathyroidism.

I had the sensation of a lump in my throat for decades. Ultrasound didn't really show much. However a CT scan of my neck and chest showed a massive retrosternal goitre in my chest. I also had raised PTH, raised calcium, low phosphate and vitamin D deficiency.

I had a total thyroidectomy and two parathyroids removed last year. Press for further scans and tests.

[PurpleNails Administrator in reply to LilacandMint]

There’s no range and no measurement included for the PTH

So it may not be high.

If unit is pmol/L it could be high by some ranges but if pg/mL it would be within the normal range.

If it is high Bookminhoca you should test calcium, vitamin D, phosphate and PTH as advised.

Needs to be at same time & sample needs to be taken close to lab, as sample has to processed quickly.

[Bookminhoca in reply to PurpleNails]

Thanks for the advice purplenails. Can I ask a possibly dumb question? Why is my vitamin b12 so low if my thyroid tests are in range?

My mum had vitamin b12 injections from around the age of 40 and folic acid but nothing thyroid related. Unless it went undiagnosed. Why are b12 and the thyroid connected?

[PurpleNails Administrator in reply to Bookminhoca]

How is your diet? Vegetarian or vegan? Many who have no thyroid issue can have nutritional deficiencies.

Your folate, ferritin, B12 & vitamin D are all not good. Your thyroid isn’t at a treatable level, but it is low/struggling.

The body prioritises preserving FT3 levels, so it’s said this it the last to be affected.

As the thyroid declines it often affects nutrients. One reason might be is causes low stomach acid, which is common with low thyroid. But the factors involved is likely far greater than this alone.

I don’t think another ultrasound will help as this type of scan does not reveal thyroid function.

Those nodules noted on ultrasound may be cold (non functioning) warm, (functioning the same of your thyroid) or hot \ toxic (hyper functioning)

The function results would suggest they don’t function but the only way to confirm this is to have an uptake scan or nuclear scan. Where radioactive iodine is taken (orally or injection) and a CT image is taken showing where the iodine has been taken up by thyroid. The most highly concentrated areas being functional & the low areas being cold.

Did you mum have pernicious anemia? Thyroid issues do often go undiagnosed, often because the basic testing is for TSH alone.

Your ferritin & iron is very low. Have you had iron panel? As well as Iron, & ferritin - Iron Saturation, Total Iron Binding Capacity (TIBC), Unsaturated Iron Binding Capacity (UIBC) & haemoglobin for is tested too.

[Bookminhoca in reply to PurpleNails]

There are a lot of words I don't understand in your message, especially about nodules but I'll look up the differences. All I remember from the first ultrasound was that it was reported 'with some micronodule diffusion and higher vascular signal' (my clumsy translation from portuguese).

I have a well balanced diet and we eat meat on the weekends. I started taking iron tablets recently as I've had heavy periods for a few years now and felt a bit more tired. We are very careful about our diet and don't eat anything processed so I don't belive it's a dietary cause.

I don't know if my mum was diagnosed specifically with pernicious anemia. I just remember she was told she had anemia and started b12 injections when I was a kid.

Thanks again for taking the time 😊

[PurpleNails Administrator in reply to Bookminhoca]

Can I explain another way? Nodules are actually common. Most are never any sort of issue.

Nodules which are bigger the 1cm are usually aspirated and the sample tested but if small that's more difficult.

Nodules can affect function because most don't produce hormone. but the remaining thyroid compensates. Some do function normally and some over function making too much hormone.

Vascularity refers to blood flow. Increased vascularity is seen in both over stimulated and strained thyroids.

[Bookminhoca in reply to LilacandMint]

Hi Lilicandmint. Thanks for your reply. I was thinking of asking for a CT scan. Or MRI. It's weeks waiting for scans so I want to make sure I get the right one.

My first appointment with the doctor has made me nervous as she sent me for an ultrasound as she said she couldn't see into my throat but the technician said ultrasound also can't see into the throat. I asked if it could be related to my thyroid and got a blank 'no' so no tests for that until weeks of waiting for the ultrasound.

I've added the ranges if that helps with the PTH level. Calcium tested at 9.4 mg/dl (range 8.7-10.4).