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Thyroid Nodules : Hi I would appreciate any... - Thyroid UK
Hi I would appreciate any advice on thyroid / Parathyroid nodules . I was diagnosed with Hashimotos 28 years ago after a partial thyroidectomy , fortunately until a couple of years ago I have had very few health issues connected. Unfortunately now due to many various symptoms I have found every day life very difficult . My limbs are painful and very weak, head cloudy and as the only way I can explain is I talk gobbledygook without realising.
My most recent symptoms being a deep husky voice , on some occasions difficulty swallowing and experiencing a very dry cough after a long conversation, which causes me to gasp to the point my eyes water.
A recent ultrasound showed that the remaining part of my thyroid is mildly enlarged and I have a nodule on my Parathyroid. I would be greatful of any advice , that may help with my symptoms. I am currently being monitored by a surgical team fir the nodule.
Many thanks
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BlueMoped32
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The parathyroid are (4 tiny glands) located very close to thyroid - but have an entirely separate function to thyroid. They can sometimes be affected during surgery but it seems from ultrasound scan there might be a nodule.
Has this been investigated further?
Such as testing parathyroid hormone (PTH). PTH it must be done on a site with lab facilities as sample has to be processed quickly.
Usually, calcium, PTH, vitamin D (possibly phosphate / & other bone profile) should be tested together.
Low vitamin D can also be an issue.
The confusion, pains & dry throat (thirst?) are common symptom with parathyroid issues.
If you wanted to read more about parathyroid here are some links for information & support
What was the original reason for partial thyroidectomy?
The thyroid ultrasound results are consistent with Hashimoto’s. Enlarged thyroid, varied echo texture & nodules.
What is current replacement dose & do you have recent thyroid function? (TSH, FT4 & FT3)
My solitary nodule is 5cm. I sometimes have minimal swallowing issues & feeling of neck pressure. I have had very similar dry throat / choking to what you describe but I have put this down to a blood pressure medication which I think will have to be changed. As my nodule hyper functions it’s managed by carbimazole anti thyroid. I have no positive autoimmune.
Thank you! your reply is really helpful. I had a large goitre removed in 1997 as it was affecting my airways.
It has only been the past 2 years or so, that I have been pretty unwell. As a result I have had many various scans and tests , requested by both neurology and spinal diagnostics .
Unfortunately it has been discovered, I have Spinal Stenosis due to degeneration in my neck C4 -C5 and C5-C6 and L4-L5 also scar tissue from previous surgery L5-S1
It was only after the ultrasound on my thyroid, that my Hashimotos was put into question. After blood tests I was prescribed low dose of levothyroxine 25mcg ( due to high BP) and advised to take high dose of vit b12 and iron. Since doing so I have seen some improvement in my symptoms. I am now currently taking 50mcg. My blood tests are now in normal range TSH & T4 . A surgical team are monitoring the nodule
I am now currently taking 50mcg. My blood tests are now in normal range TSH & T4 .
Please add actual results and ranges
Was test done early morning and last dose levothyroxine 24 hours before test
50mcg levothyroxine is only the standard STARTER dose
Highly likely you are ready for next dose increase to 75mcg
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
I was Diagnosed with Hashimotos after partial thyroidectomy 1997. After which I had regular 6 monthly appointments with my Endocrinologist for a few years which then changed to yearly.
After 12 years I was discharged and left under the care of my GP who was requested to retest my bloods yearly , which I always seemed to chase up and never get results for and as far as I am aware it was onlt the TSH . Thankfully I have 'Patients Know Best' so am able to see my results and chase them up if need be.
when adequately treated on levothyroxine most people will need Ft4 (Levo dose) at least 60-70% through range…..when tested 24 hours AFTER last dose of levothyroxine
Currently
Free T4 (fT4) 11.4 pmol/L (9 - 22)
Your Ft4 is only 18.5% through range and this was with test done only approx 10-12 hours after last dose Levo
If you had tested 24 hours after last dose quite likely Ft4 would be below range
Request increase in dose to 75mcg
Retest in 2-4 months time…..likely ready for further increase by then
I am so confused, I have been unwell for nearly two years just being passed from pillar to post, as I have so many symptoms. Currently under Neurology Cardiology and Surgical team. I'm currently taking High dose vitb supplements and my usual calcium Adcal
Current treatment of hypothyroidism is woefully inadequate
They SHOULD follow guidelines and slowly increase dose levothyroxine up until you are on at least 100mcg daily (unless extremely petite)
Guidelines on eventual dose levothyroxine is approx 1.6mcg per kilo of your weight per day
approximately how much do you weigh?
When adequately treated on high enough dose levothyroxine likely to bring Ft4 (levothyroxine) to roughly 70% through range when testing correctly with last dose levothyroxine 24 hours before test
Levo does NOT top up your own thyroid output…..it replaces it
Book early morning test ideally before 9am,…..or before 9.30am
As you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning…..
delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning.
Take Monday evening dose levothyroxine as per normal
High dose vitb supplements
B vitamins best taken immediately after breakfast
IMPORTANT …..If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In days before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 if last test result serum B12 was below 500 or active B12 (private test) under 70
and my usual calcium Adcal
are you taking this at least 4 hours away from levothyroxine
How much vitamin D is in this
Retest vitamin D, folate, ferritin and B12 at least once a year
Thank you so much for that valuable advice. I did have an appointment with the pharmacist at my GP a while ago who was really helpful. He confirmed I was taking my medication and strong pain killers at the appropriate times. Ensuring all my meds would be at there most effective. I am Female
58 years old
5ft 10,
12 and half stone
Thank you again for taking the time to give me advise
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