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Suggest Remedy For Bad Sensation In Throat After Thyroidectomy

Posted on Tue, 27 Jan 2015

Question: Dear Doctor,
I'm suffering from constant bad feeling in throat for months, and not feeling any better. The feeling is strong and very much inside the throat, feeling mass/lump/twisted… I can't lead normal life due to it, and desperately need help!
I've had surgery of thyroidectomy in May 29 2014 due to papilary thyroid cancer. I didn't take thyroxine during Jun 4 - July 18 due to herbal medicine treatment and therefore fell into severe hypothyroidism. Since I started taking thyroxine from July 19 and gradually increased the dosage, my various hypo symptoms disappeared while the bad throat feeling remains untill now. The recent physical tests doesn't show structure problem (including neck ultrasound, gastroscopy and laryngendoscope), but the feeling in throat is very true and strong. My current medication includes thyroxine(112.5mg), dexilant and remeron.
XXXX

Answered by Dr. Shehzad Topiwala (30 minutes later)

Brief Answer:
Thyroid

Detailed Answer:
I am very sorry to learn about your neck symptoms.

I have reviewed your attached summary. It is quite clear you have been thoroughly investigated for potential causes of your neck complaints and unfortunately nothing has come to light.

When I see someone like you in my practice, I tend to typically order the following blood tests, obviously in addition to a thorough physical examination:

CBC
CMP
TSH
Free T4
Quantitative Thyroglobulin
Anti thyroglobulin antibodies

Some of the tests above are markers to see if there is any residual thyroid tissue in the neck.

It would be most advisable for you to be under the care of an endocrinologist experienced in the management of thyroid cancer. A comprehensive academic center with expertise in dealing with thyroid cancer, would perhaps be an even better choice.

There are specific TSH and free T4 targets that need to be adhered to, in order to prevent the cancer from coming back. However, these decisions require application of latest guidelines that have undergone changes as recently as few months ago.

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

Follow up: Dr. Shehzad Topiwala (15 minutes later)

Dear Dr. Topiwala

Thanks a lot for your prompt reply.

My most recent blood test results are as followings:

Oct 21 2014
               Reference
TT3     0.77     ng/ml     0.6-1.8
TT4     11.50     ug/dl     4.5-10.9
TSH     0.08     uIU/ml     0.35-5.5
TGAb     21.60     U/ml     0-70
TP0Ab     57.80     U/ml     0-70
TG     <0.20     ng/ml     1.7-56

I also attach another blood test report for your review. I'm wondering that if these blood test results are related to my current neck/throat symptoms.

Great thanks!

XXXX

Answered by Dr. Shehzad Topiwala (5 hours later)

Brief Answer:
Follow up

Detailed Answer:
Your thyroid blood test results seem to be on target. It is important to follow up regularly with an endocrinologist to ensure the values remain at goal for the intended period of time.

I have seen the other laboratory test result that you have attached. It is a CBC. It is more or less ok.
It would be helpful to review the CMP which stands for Complete metabolic Panel. It includes the following blood tests:
Electrolytes
Glucose
Calcium
Creatinine
SGOT
SGPT
Albumin
Globulin
Bilirubin
bicarbonate
Alkaline phosphatase

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

Follow up: Dr. Shehzad Topiwala (5 hours later)

Dear Dr. Topiwala,

Thanks for your futher explanation. I had a CMP test in July and the result was OK then. But I'll redo a blood test for all the index you mentioned.

Upon your suggestion, do you know any appropriate doctor/institution in Toronto that I can go to for monitoring and analyzing my situation, especially to help sovle my neck/throat feeling problem? I've found "UHN XXXXXXX XXXXXXX Cancer Center" on internet, and they have a team of Head & Neck Clinic and Endocrine Clinic. Have you heard of them and should I go to see them?

Thanks a lot.

Answered by Dr. Shehzad Topiwala (14 minutes later)

Brief Answer:
Second follow up

Detailed Answer:
There is Dr XXXXXXX Drucker at University of Toronto. You can check with either center if they have the expertise and experience dealing with your condition.

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