Doctors Lounge - Endocrinology Answers
provided on www.doctorslounge.com is designed to support, not
replace, the relationship that exists between a patient/site
visitor and his/her physician."
Back to Endocrinology Answers List
- Sun May 15, 2005 1:25 am
I am a 46-year-old woman, overweight, with symptoms of fatigue and borderline
high blood pressure. A blood test recently indicated a slightly elevated TSH
(thyroid stimulating hormone) level.
I have acid reflux due to being overweight and having a hiatal hernia, plus lately
I have had more acid, throat pain, and some ear pain in the morning upon arising.
Lately I also notice more tickling in my throat and the sensation that perhaps a gland
is swollen in it. Also I have been looked at because I have swollen lymph glands under
my arms (doctors checked for breast cancer and tests have not shown any sign of it)
The nodes are not hard to the touch, but more of the infectious type.
I take provera tablets to control my menstrual cycles. I took birth control pills for over
ten years to control heavy periods and related female problems. I then became an
infertility patient at a large clinic and successfully became pregnant and had a healthy
baby girl by c-section in 2000. Prior to becoming pregnant I had surgery to remove
a large fibroid and I also have polycystic ovarian syndrome.
I would like to know if my hormonal history and my current symptoms suggest
hypothyroidism or some other problem with my throat? I will visit the internist next
week to discuss my blood test, and apparently everything came back okay except for
the elevated TSH. I am worried by the throat pain, which seems to be in the tissue
of my throat, and I wonder if a thyroid nodule is there/
Thanks for your kind help!
| Dr. S. Adhikari
- Sun May 15, 2005 3:12 am
As far as your symptoms go, you might jolly well be hypothyroid; again, I need to know your TSH and free thyroid hormone levels before I can comment. I suggest you go in for an oral examination and a clinical examination of your neck although similar symptoms can be elicited by GERD.
Your palpable nodes under your arms are definitely a concern at this age. If mammography has not been dne, I recommend it highly. Also, do you have any sort of infection in your hands or arms? Check out your blood sugar at the same time.
- Wed May 18, 2005 1:38 pm
Hi Doctor and thank you for your previous and very helpful reply. Here is the latest and
I would appreciate your opinion about it. They did one thyroid-related test, the TSH and it
came back as 7.15. Everything else in my bloodwork and urine test came back normal--
RBCs and WBCs are normal, urine is normal, glucose is normal (84), and my readings for
"comprehensive metabolic" were normal. The only abnormal result was the high TSH,
and its reference range "yardstick" was listed as .27-4.20. Also my blood pressure was
around 147/96. The doctor was not there and so they assigned a physician's assistant
to me---he was helpful. He suggested that I go on a low dose of thyroid medicine,
saying I am slightly hypothyroid so he wrote a prescription for "levoxy--something" and
also a prescription for blood pressure meds, saying that at leas for now I should go on
them, til I am able to get my weight down a bit, as I am overweight. I told him about my
throat symptoms and he said that goiter only goes with hyperthyroid and not hypothyroid,
which is the one I have. I asked him if we should scan for a nodule on my thyroid,
but he did not seem to think it was necessary. However, since I have had someodd sore
throat symptoms which seem a bit different from my usual acid reflux, and since I
have a high tsh, do you think I should have a scan to look for thyroid nodules or
thyroid cancer? I do not smoke or drink so hopefully it is not a throat cancer but I
do wonder what it could be. I realize that thyroid cancer and throat cancer are actually
two different things but anyway would like your opinion. I continue to have on and off
hoarseness too, some ear pain and sinus pain. Ih ave read that these can indeed by
thyroid related but don't know if that applies to me. Thanks for your help!
Sincerely, Lisa, firstname.lastname@example.org
| Dr. S. Adhikari
- Thu May 19, 2005 12:52 pm
Yup, your TSH is on the higher side! Judging from all the facts, I would recommend you to take 25 microgram of levothyroxine in empty stomach before breakfast every day. We can then monitor the TSH level after about a months' time and then I can suggest yu further. Do remember that one of the major functions of TSH is stimulating growth of the thyroid gland so there is no alternative to a clinical examination!
About your hypertension, I won't label you as a "hypertensive" until you have documented elevation in blood pressure on 3 separate occasions. Record your BP on 2 more occasions and then I'll suggest you another medication for the same.
Don't be worried for being overweight: just try to have some regular exercise and cut down on your junk foods. Try to go in for a diet chart of 1500 kcal to begin with and then taper down to 1000 kcal until you have achieved your desired weight loss. Once you lose weight, you'll feel mentally and physically much better and your BP would come down too!!!
| Lisa K, RN
- Fri May 20, 2005 11:50 pm
Yes, your TSH is definitely elevated but what's more important is what your Free T4 and T3 levels are - those are the actual hormones that the thyroid gland produces.... TSH is "thyroid stimulating hormone".....if it's elevated, it means your thyroid is working extra hard to produce the correct hormones ........... people w/ underactive or "hypothyroidism", their hormones will be on the low side..which is why you're supplemented with the levothyroxine.
Just so you know, a person w/ hypothyroidism CAN definitely have a hoarse or husky voice...and the strange feeling you have in your throat, that CAN be present for those with HYPOthyroidism, too....particularly if you have Autoimmune Thyroiditis (which a person can have thyroid nodules).
I highly recommend the following site....I belong to it myself (I have autoimmune thyroiditis).......they have message forums like this one .... where you can learn more about thyroid disease, speak with others who have either hyper or hypothyroidism, learn more about symptoms, blood tests, etc.
The following link (just click on it) will give you great info on thyroid nodules, goiter, symptoms of hypothyroidism, etc:
You might want to join the Forums there, so you can learn more about hypothyroidism, and ask any questions you might have. (I'll post the link below). You might also want to ask your doctor for a referral to an Endocrinologist - that's a specialist who deals with issues/conditions of the thyroid gland.
Your blood pressure at your appointment was definitely elevated but it also could have been elevated a little due to just the anxiety of being at the doctor's office, and your concerns about your symptoms. Now that you're on this BP med, be sure you get your BP checked weekly at least.....if at your doc's office or if you have one of those home BP machines.....or your local clinic/health unit. The only way your doc can know if it's the correct med/dose is if you have your BP checked regularly, keep a log of the readings..to show him.
Also, your TSH and T4/T3 levels should be rechecked in 2-3 months.............to ensure your dose (it's a relatively low dose) doesn't need to be increased.
I have autoimmune thyroiditis...which caused me to be hypothyroid. When I was first diagnosed, the doc (not my regular one) started me out on a very low dose like yours......but I asked for a referral to an Endocrinologist..and he increased it (3 months after diagnosis, based on new bloodwork) it to 100mcg.
- Tue Sep 20, 2005 11:54 pm
Hello. I am not a doctor, but have reflux and maybe a thyroid problem. I also feel funny with my ears, like pressure. Try apple cider vinegar for the reflux. You can find information about it by searching it out on the internet. So cheap, no copay or big prescription price. Something about the level of acidity in it makes your digestive system respond appropriately. Good luck and I hope we both can loose some weight. Tea and caffeine upset my reflux. We should drink a lot of water and other better alternative drinks like juices and herb teas. Keep us posted on your progress.
- Wed Sep 21, 2005 12:00 am
PS- Your hiatal hernia might not agree with the apple cider vinegar. Anyone have any suggestions? Maybe you can try it when you are feeling your best.
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit
Ask a Doctor Teams: Respond to patient questions and
discuss challenging presentations with other members.
Doctors Lounge Membership