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Does Hormonal Dysfunction Cause Throat Discomfort?

Posted on Mon, 23 Feb 2015

Question: Dear doctor,
1. Is my current dosage of thyroxine appropriate?
2. Is my current symptom at the base of throat/upper esophagus area related to the hormone level change after thyroidectomy?
3. Is the change in my menturation pattern (much lighter flow) related to thyroidectomy?
4. What else should I check for blood test?
5. What else can I do to explore the reasons behind my current symptom?
Thanks,
XXXX

Answered by Dr. Binu Parameswaran Pillai (4 hours later)

Brief Answer:
Globus hystericus a possibility

Detailed Answer:
Good day,

Sorry to hear about your symptoms. I went through the atttached reports. Would like to know couple of things. How large was the papillary thyroodi cancer? Do you have the biospy report ?

TT4 is it the total T4 ? . I would like to know the Free T4 ( FT4) report.

You seems to have been invetigated thoroughly and no cause of throat symptoms was found. Two gastroscopies have been normal. Also, noted that you have been stopping thyroxine in between for herbal treatment. Stoppping thyroxine can make your symptoms worse.

Since most investigation regarding your neck was negative, your symptoms may be due to " Globus Hystericus" where there is a constant lumpy feeling in neck. This is often associated with anxiety. However, you may need your throat examined by an ENT doctor to look at your vocal cords.

The TSH levels are okay as we need it to be suppressed for few years after thyroidectomy for papilary thyroid cancer. Please take Calcium and vitamin D along with Thyroxine so that your bones are protected.

The scanty periods which you are getting may be due to slightly excess dose of thyroxine or due to the antidepressants which you are taking. It is worth checking the PROLACTIN LEVELS. This is the only extra test which i need.

I would appreciate if you could answer my question regarding the size of thyroid cancer and the biopsy report.

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (12 hours later)

Dear Dr. XXXXXXX

Thank you for the reply. The cancer size is small which is 0.3x0.4cm, and biopsy report showed that it was encapsulated and no spread to lymph cells. The blood test on Oct 21 2014 I have is total T4, no free T4 available. And the blood test in Dec 29 2014 is free T4 for your judgement. And ENT doctor has checked my throat and found no damage on vocal cords.

I have some more questions to ask your advice:
1. What is the target of TSH for my situation?
2. Is there any target of free T4 for me?
3. Should I also montitor TG level? What is the target then?
4. When should I do blood test again to monitor the related indexes?
5. To check the PROLACTIN LEVELS, is it required to be on certain day of menturation period?
6. I'm currently taking multi-Vitamin which includes 330mg Calcium and 25mcg/1000IU Vitamin D3 per day. Is it enough?

Thanks,
XXXX

Answered by Dr. Binu Parameswaran Pillai (2 hours later)

Brief Answer:
Answers

Detailed Answer:
Thank you for the reply.
So you had a micropapillary thyroid ca ( less than 1 cm in size)

You should target for a TSH of between 0.1 to 0.5 atleat for 5 years and Free T4 in the upper normal range. It is usual for FT4 to go just above normal when we try to acheive TSH of this range.

Your TG ( while on Thyroxine) should be < 1 ng. If it is more that this, you may need a timulated value. However, we also look at Anti TG antibody when we measure TG. If Anti TG antibody is detectable , TG measurement i not valid.

You should do the tests 6 months after the lat test.

Prolactin is best done in the morning, irrepective of mensturation period.

Your Calcium tablet should contain atleast 500 mg elemental calcium and rest you should get from diet ( we aim for total 1000 to 1200 mg a day from diet and by supplement). vitamin D intake seems to be okay.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (19 minutes later)

Dear Dr. XXXXXXX

Thanks for the detailed explanations. According to my recent blood test dated 2014.12.29 as attached, are all the indexes on target? I'm not sure about my Anti TG antibody which is now 20KIU/L.

Thanks,
XXXX

Answered by Dr. Binu Parameswaran Pillai (11 minutes later)

Brief Answer:
On target

Detailed Answer:
your Tg antibody is detectable and hence TG measurement is not reliable.

Ultrasound of neck should be done in this case. Your Ultrasound scan also didnt show any abnormality. Every 6 months do Tg and Anti TG. Gradually Anti TG levels will decrease and in that case, TG meaurement will be reliable.

Other blood reports seems in target

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (8 minutes later)

Dear Dr. XXXXXXX Thanks a lot for your prompt reply. It's very clear. XXXX

Answered by Dr. Binu Parameswaran Pillai (1 minute later)

Brief Answer:
Thank you

Detailed Answer:
my pleasure. Wih you good health.

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar