Throat/Glands Swelling Question

[Juliet_22]

Hi All,

Ever since my thyroid went out of balance, for the first time ever I've started to experience strange throat sensations:

* Sore throat, like a cold coming, but no cold

* A feeling of swollen upper neck glands when they are not really swollen in reality

* Voice changes at times

The thing is that all these symptoms come and go. I can be totally fine for a while and then the discomfort comes back. Sometimes it's a feeling of a sore throat. Or swallen upper glands. Or my voice changes.

I've seen a GP about it, had throat swabs done before and they have found nothing.

Had a thyroid ultra sound scan, usual Hashi picture with a small thyroid gland.

Had a stomach untrasounds, liver checks, kidney, etc. Glands are not swallen.

My GP said "let's put you on acid reflux meds to see if that helps" but I don't have other symptoms and don't want to take the acid reflux meds for no apparent reason.

First, it was related to being hypo. But then I balanced that and my TSH was suppressed T3 66% of the range and T4 50% of the range.

So now it's definitely not a hypo problem any longer.

I started to experience it on levo when I was hypo. A while later, I switched to NDT - on and off again and it got worse, so back to levo again (and for other reasons as well) and it's still there on and off.

Yes, I have Hashi, but I've been having it for well over a decade and have never had such weird symptoms.

I check all the vital nutrients and keep them in ideal ranges through supplements. Already eat a gluten free, plant and anti-inflammatory diet. I take Betaine too.

My white blood count is usually either below the range, or right at the bottom of it. I know it's Hashi related, but no sure if it's throat related. Other full blood count markers are good.

I can't make sense out of it. Has anyone experienced it before and what's the best way to balance it please?

[greygoose]

Sounds like a lot of the symptoms I had before I was diagnosed.

First, it was related to being hypo. But then I balanced that and my TSH was suppressed T3 66% of the range and T4 50% of the range. So now it's definitely not a hypo problem any longer.

I don't think you can say that with any certitude. Could be you need your FT3 even higher - some people need it over the top of the range to feel well. And a lot of people need their FT4 higher than that. Remember, a blood test is just that: to tell you what's in your blood. Hormones don't do anything in the blood. They have to get into the cells. And there's no way of testing what gets into the cells. So, blood tests are just rough guides at best.

[Juliet_22 in reply to greygoose]

Thank you so much for adding this! I can't raise my T3 any higher, I was getting discomfort in the heart and heart pals. It all balanced now after I came back to levo. But I will try to add very small dose of synthetic T3 again ... for the 4th time ... maybe this time I will be able to tolerate it!

[greygoose in reply to Juliet_22]

You're welcome.

[Lalatoot]

Yep. Before I was on t3 and particularly when I was undermedicated on levo I used to have this all the time. Used to lose my voice. Friends would remark on how hoarse I was .Now I occasionally get a little hoarse when I've been really busy but no sore throat, swollen glands or loss of voice.

[Juliet_22 in reply to Lalatoot]

It seems that T3 is the answer to this!

[radd]

Juliet_22,

Your symptoms sound like classic Hashi attacks and you recently said your thyroid antibodies have increased since being on NDT. This is common problem for Hashi sufferers if you can't raise quickly enough to prevent thyroid activity.

Hashi doesn’t just destroy the thyroid gland by thymocyte destruction but can infiltrate the lymphatic system, usually the neck glands that are nearest to the thyroid gland. I used to get swollen neck lymph nodes as a teenager, but sometimes also underarms and groin. It made me feel extremely unwell with flu like symptoms and complete lethargy. All I was ever tested for was glandular fever which always came back negative. The voice changes didn't occur until I was in my forties just before being diagnosed.

Lymphocytopenia is very common in Hashi. We literally wear out after years of internal autoimmune fighting, which conventional medicine doesn’t understand because unless you have an elevated WBC there’s nothing wrong.

[radd in reply to radd]

I have just been looking at your past posts and you mention low sodium levels.

Indirectly T3 helps control the potassium/sodium levels and compromised adrenals are classic in unmanaged hypo/Hashi and will actually leech sodium from the cells. Therefore, low sodium lab levels are common and it must be replaced.

Some take an adrenal cocktail (Google it for ingredients). I just eat salty crisps (coz I love 'em 😁).

[Juliet_22 in reply to radd]

This is so interesting, thank you so much! Thing is that I had Hashi for a long time and it only all popped up when things went out of balance. Now trying the get them back into balance!

Groin swelling - that's so interesting. I have a lot of chronic groin pain. There's no swelling, but I feel pain there. Do you think it's related?

[radd in reply to Juliet_22]

Juliet_22,

Before diagnosis I suffered chronic pelvic pain that intensified around the time of my period which were simply awful.

Research shows a distinct connection between chronic pelvic pain and hypothyroidism, although the exact mechanisms still remain unknown. (As a side note -endometriosis tests on mice evidenced [unsurprisingly] thyroid hormone levels heavily influenced the size of the endometriotic implant).

Thyroid antibodies by their very nature are a form of chronic inflammation sending out further (unwanted) inflammatory signals by upregulating the release of molecules such as prostaglandins, and/or eicosanoids, and histamine. These can cause us aches and pains and I think like any trauma, unmanaged Hashi lowers our tolerance threshold, eg we hold more inflammation and are more sensitive to it. We feel more cold, more hot, we heal less well, exercise recovery is poor, illness recovery is slow, stress response accelerates, etc.

Histamine is naturally released to stimulate the ovaries to secrete oestrogen during the monthly cycle. Higher levels of histamine can create higher levels of oestrogen. High oestrogen impairs DAO from degrading histamine, leaving levels to accumulate even higher. Many Hashimotos sufferers become intolerant to an overload of histamine providing yet another layer to Hashi’s complexities. Oestrogen is also closely connected to prostaglandin and eicosanoids release.

‘Thing is that I had Hashi for a long time and it only all popped up when things went out of balance.’ Have you considered it’s the long term effects of an insidious unrelenting Hashi that has upset the 'balance' as opposed to the the ‘balance’ instigating a Hashi attack? You sound as if you have an awful lot of symptoms that you haven’t connected to thyroid issues.

All the while you have thyroid tissue it is vulnerable to autoimmune attack and Hashi has no time limits. My (unknown Hashi) attacks started in my teens but I didn’t start replacement meds until late forties. Four years later scans showed my thyroid gland to be completely atrophied.

If attacks and antibody levels have sudden increased since starting Efra, the NDT could be a likely cause when your body interprets it like own thyroid gland tissue and attacks as in autoimmunity. Some people can suppress thyroid activity enough by adjusting their meds but others simply can not tolerate NDT.

I can’t see your labs, only your misplaced worry re low TSH & osteoporosis. There is no research evidencing a low TSH to influence bone health. It is thyroid hormones that dictate bone architecture with too little or excess causing brittle bones, and a low TSH is just a secondary consequence.

If you post your labs, members will comment.

[Juliet_22 in reply to radd]

This is so interesting! I've saved this info to read and digest later. Suppressed TSH wasn't an issue for me on NDT, it was a range of other symptoms that popped up, inc how it had elevated my anti-bodies. What you explained is so valuable, thank you so much for taking your time to anwer.

[Griffo_ in reply to radd]

Wow, I never knew this! I only recently found out I have hashimoto’s, but checking my blood tests all the way back to 2018 show that I’ve always had under-range lymphocytes! Probably explains all the swollen lymph nodes I get. Also why it takes me ages to get over colds!

[Juliet_22 in reply to Griffo_]

Yes, I reviewed mine a few years back. It swings from low normal (which is normal) to a bit under range. I've consulted with a doc about it and they said it's typical for people with Hashi.

[JoJoloveschocolate]

So glad you asked this question. I’ve literally got this same issue at the moment and have had it on and off for a while. I started a thyroxine trial 50mcg in May this year and have just, today, been increased to 75mcg. These symptoms come and go for me too! I feel exactly like you say - sore throat, like a cold coming on/flu, and if I talk too much my voice sounds hoarse/strained and people comment on it. I also feel shivery when it happens and I usually have to go to bed for a few hours. Sometimes it also seems to randomly trigger the swallow reflex (if that makes sense). All I can say is that I’m undermedicated at the moment. I also had positive tg antibodies which I believe can also suggest Hashis. Hope you feel better soon.

[DippyDame]

Absolutely! Several years ago my GP was going to refer me to ENT, I had a very croaky voice... but I increased my T3 and it all cleared....I need high dose T3-only to function

I had (and still get the sore neck/ glands feeling) when/if I need more T3.

I'm on holiday at the moment and been gadding about quite a bit and my glands/body, and dropped energy levels, started to scream ...stop we can't keep up we are undermedicated for this malarky. I added a tiny bit more T3 and it helped.

How we feel is vitally important ( medics usually forget this!!)

Listen to your body it will soon tell us if something is wrong.

Forget TSH....once medicated, particulary if T3 is added....or in NDT...science has shown it's an unreliable marker.

FT3 followed by FT4 are the important results

FT3 at 66% through range is not excessive...so long as result is within range, and you feel well, there is little chance you are overmedicated. Monitor regularly for any symptoms.

Medics will diagnose all sorts of ailments when in fact it's just a case that FT3 is too low

For good health almost every cell in the body needs to be flooded with T3 in a constant and adequate supply

Low cellular T3 = poor health

I'd be fairly sure that you need more T3....I've travelled that long bumpy road and made it to age 78 so I can tell you that " doctor doesn't always know best". They left me a complete wreck ....this forum knew best!!

Good luck!

[Juliet_22 in reply to DippyDame]

Thank you! So glad you solved it. Very interesting about more T3!

[DippyDame in reply to Juliet_22]

Here, many of us understand how vitally important T3 is to the whole body . We have learned from the work of doctors and scientists who were/ are experts on the subject including our advisor Dr John Midgley ...aka diogenes

However, I'm afraid medics are often clueless beyond TSH which has (partly) resulted in nearly 140,000 patients seeking help here.

It beggars belief!

Do you know the status of your T4 to T3 conversion?

Have you optimised vit D, vit B12, folate and ferritin?

Your hormone levels will fluctuate withHashi's....a gluten free diet helps very many. Which may account for feeling your symptoms are " on and off"

[Juliet_22 in reply to DippyDame]

Thank you! Already on a GF and great diet. Yes, all the nutrients are good! How do you work out the status of T4 to T3 conversion and what should it be? I convert from levo to T3. But a bit extra T3 might help too as I am off NDT now.

[DippyDame in reply to Juliet_22]

Simplest way....If FT3 is low with much higher FT4 then T4 to T3 is impaired....the greater the gap the worse conversion is likely to be.

Generally FT4 and FT3 should be close to the same level

Or...

To work out conversion rate of T4 to T3, as long as the unit of measurement is the same you divide the FT4 result by the FT3 result. Good conversion is said to take place when the ratio is 4:1 or less, over 4:1 suggests poor conversion.

I had the Dio2 genetic test to check for the polymorphism....conversion is likely to be worse if that is inherited from both rather than just one parent. In my case homozygous/ both parents.

Worth trying a little more T3....say 2.5 mcg, maybe even 5mcg, to start.

It's trial and error I'm afraid....and time!

[Juliet_22 in reply to DippyDame]

Yes, thinking of adding a bit of T3, like 2.5 mcg to see. When adding a small dose of T3, do people generally reduce the dose of T4?

[DippyDame in reply to Juliet_22]

How much T4 are you taking?

Adding T3 will naturally lower both TSH and FT4 ....but not a lot initially with 2.5mcg.

Try adding a further 2.5mcg after a week, if that feels ok add another 5mcg after 2 weeks (now 10mcg total)

If that feels fine with no symptoms of overmedication then add another 5mcg (15mcg total)

At that point I'd be inclined to hold that steady dose for 6 weeks then test again

The results of a test....at least TSH, FT4 and FT3....will then point to the way forward.

Post the new results for advice

[1tuppence]

Thank you. These answers to your questions are so interesting to me, as my voice is going hoarse again. I've started taking Erfa with reduced levothyroxine, and wonder if my dose of hormones is now too low. I'm not a good converter T4 to T3. I had full blood tests taken this morning not related to thyroid, but thyroid hormones will be tested anyway, so results will be interesting.

[Juliet_22 in reply to 1tuppence]

It actually got much worst for me on Erfa with regards to this issue, I changed to levo and it got better right away. But now it's on and off again, at least not constant like it was on Erfa.