Substernal/Compressive Goiter advice/opinon/help - Thyroid UK

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Substernal/Compressive Goiter advice/opinon/help

Serisu profile image
11 Replies

Hi! I hope you are all well.

I was just wondering if anyone could offer any advice/opinions on my current thyroid situation.

In July I was diagnosed with a ‘severely overactive thyroid.’ I was put on Carbimazole but then my levels went too low so I was taken off the tablet.

during this time I was getting a lot of discomfort in my throat, constantly feeling like someone was pushing down on my throat with a lot of pressure, changes in my voice, trouble swallowing sometimes, a big fullness feeling in my throat. I went back to the doctor who expressed concern that I had a substernal goiter after feeling my throat and being unable to get behind my right side collar bone and feeling a lot of resistance. She referred me for a scan which was cancelled and I was sent to a consultant. He felt my neck and said he couldn’t feel a goiter but couldn’t say why the one side of my throat behind my collar bone can’t be pushed in. He said that he thought it was acid reflux and has put me on tablets despite not having any of the main symptoms of acid reflux or anything similar. He said that they could do a ct scan but he didn’t want to because ‘7/10 come back as abnormal’ so told me to wait for my endocrinology appointment so they could refer me back to him, which could take up to a year.

My parents, who were both nurses, and a family member who is in the medical profession are all doubtful that this is the case.

So I was just wondering if anyone had any similar experiences? Or if this was ‘normal’?

Can you have a substernal or compressive thyroid but not actively feel a lump in the throat because it’s growing inwards/downwards?

Are there any other reasons why I can’t get behind my collar bone on the one side and now occasionally on the other?

I’m going to speak with my normal GP Friday but I was just wondering if anyone had any similar experiences.

Thank you for taking the time to read, I’m sorry for waffling.

Take Care:)

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Serisu
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11 Replies
SlowDragon profile image
SlowDragonAdministrator

Suggest you get ultrasound sound scan privately now

thyroiduk.org/?s=Ultrasound+

In July I was diagnosed with a ‘severely overactive thyroid.’ I was put on Carbimazole but then my levels went too low so I was taken off the tablet.

How long since you stopped Carbimazole

You should have had TSI or Trab antibodies tested for HYPERthyoid autoimmune disease - called Graves’ disease before starting Carbimazole

And need TPO and TG antibodies tested for autoimmune HYPOthyoid disease- called Hashimoto’s

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms (as cells breakdown and release excess thyroid hormones) …. before becoming increasingly hypothyroid

request FULL thyroid and vitamin testing via GP including TPO and TG antibodies , TSH, FT4 and FT3 tested

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

Low vitamin levels are extremely common especially with autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

NHS only tests TG antibodies if TPO are high

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

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

Essential to test vitamin D, folate, ferritin and B12

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

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

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

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

He said that he thought it was acid reflux and has put me on tablets despite

Most hypothyroid patients have LOW stomach acid (and this can result in acid reflux)

Omeprazole or other PPI can exacerbate this

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...

branchbasics.com/blogs/food...

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

huffingtonpost.co.uk/laura-...

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

Useful post and recipe book

healthunlocked.com/thyroidu...

But never assume you have low stomach acid

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

Ppi like Omeprazole will lower vitamin levels even further

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

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

pharmacytimes.com/publicati...

Serisu profile image
Serisu in reply toSlowDragon

We were considering going private, even just for peace of mind.

I came off the Carbimazole around the 28th of October.

I’m not aware of having those tests done, just follow up bloods to check my levels.

The consultant I saw yesterday did however say when he saw me ‘so you have Graves disease’ and I was like no? I’ve never been told that’s something I have or something that’s even been mentioned. I’m going to mention it when I speak with my GP next.

I have had a lot of issues with my Vitamin D and folic acid levels. I was prescribed folic acid and vitamin d tablets which I’m not on anymore. My GP wanted my levels to be between 70-100 but I’m not sure what they are as my GP surgery couldn’t find the results of my last vitamin d test.

My next bloods are at 8.40am so fits in well with that, I’ll make a note - thank you.

I’ve had no tests related to my stomach acid or anything and had mentioned to the consultant about my history of vitamin deficiencies and how fast my levels drop. I’m going to speak with my GP before taking any so that I don’t make anything worse.

All of those links and the information is super helpful, so thank you so much for that. I appreciate your time and knowledge very much

SlowDragon profile image
SlowDragonAdministrator in reply toSerisu

We see small, but steady number of Hashimoto’s patients misdiagnosed as having Graves’ disease if all antibodies are not tested

Serisu profile image
Serisu in reply toSlowDragon

I’ll mention that to my GP, thank you so much for all of your help and advice. I appreciate it very much

SlowDragon profile image
SlowDragonAdministrator in reply toSerisu

see exactly what has been tested

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

This currently only applies in England, not across the whole of the UK. Nether Scotland nor N.Ireland have released an NHS app for patients. (Scotland supposedly due in December '24.) Wales has an app, but only for booking appointments, repeat prescriptions and amending personal details

Link re access

patients-association.org.uk...

healthunlocked.com/thyroidu...

In reality some GP surgeries still do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Serisu profile image
Serisu in reply toSlowDragon

I have a couple of printed copies of my levels but it’s just the TSH and T4 levels. I’m seeing the doctor tomorrow so hopefully will have some more answers!

Separately - have you had or do you know if thyroid issues can cause extreme anxiety? The past couple of days I have been experiencing completely extreme nervousness and anxiety about everything. I am having a breakdown a day minimum and feel sick constantly. Do you know if that can happen?

SlowDragon profile image
SlowDragonAdministrator in reply toSerisu

Anxiety is very common when thyroid levels aren’t right

You need FULL thyroid testing including thyroid antibodies and vitamin levels

Make sure to test early morning

Serisu profile image
Serisu in reply toSlowDragon

My doctor moved my bloods forward to Monday at 8.30 so hopefully they will be able to give some leads as to a way forward to help.

I really appreciate all your time and advice, it means a lot. Thank you

pennyannie profile image
pennyannie

Hello Serisu and welcome to the forum :

Do you have on-line access to your medical records held at your surgery - if so can you please share the results and ranges of the blood test that prompted the prescribing on the Carbimazole ?

Carbimazole is an Anti Thyroid drug and blocks your new, daily, own thyroid hormone production - maybe it was just the dose of the Carbimazole that was too high for your T3 and T4 results ?

Can you see if anyantibodies were run - these would look like TPO - TgAB - TSI - TRab - or reading as a TSH Thyroid Receptor ab - with ranges and / or single number cut off levels ?

If you haven't on-line access please arrange this through the surgery receptionist as then we are better placed to help and answer your questions.

Serisu profile image
Serisu

Hi! Thank you for responding.

I don’t have online access but I have print outs of my results.

I was on 5mg of Carbimazole for about 5 weeks I think. I haven’t had any since September ish time.

My thyroid levels are now underactive and have been for a while.

My doctor has written to a specialist as they keep fluctuating so much so hope fully that will lead to something.

My first bloods that lead to the carbimazole were from the 15th of July :

serum TSH level - 0.2 ‘low’

serum free T4 level - 23.9 ‘high’

Since then my results have been from September and October

September

serum TSH level - 21.90 ‘high’

serum free T4 level - 11.9

October

serum TSH level - 11.59 ‘high’

serum free T4 level - 9.5 ‘low’

Jaydee1507 profile image
Jaydee1507Administrator in reply toSerisu

Suggest you start a new post with these results for more responses.

As you have replied to yourself noone will get a notification.

If you want somene to get an alert of your reply, use the reply button directly below their response or you can tag people separately by typing @thenthepersonsmembername

You look very hypo at the moment.

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