Nerve pain after total thyroidectomy

[SarahE86]

I had a total thyroidectomy in May of 2009. Right after that surgery i had pain, numbenss, tingling in my arms. A few months later there is sharp shooting pain down my arms into my hands, muscle weakness bad enough where applying pressure to a pen to write is unbearable. I have had many tests done, ana, Ra, calcium, vitamins, and everything is normal.Ive had nerve conduction tests which came back normal and an MRI if the cervical spine which is normal. I have seen 3 Neurologists, 1 Neurosurgeon, 2 rheumatologists, 1 pain medicine doctor, 1 chiropractor, 1 endocrine doctor, and my primary care several times. All doctors have told me they cannot help me. It is discouraging but i am having extreme pain, blurry vision with pain down my arms and a migrane, which the migranes did not appear until recently. I have been on many pain meds, which offered no relief.

I have done some research and found articles about a RARE complication after a thyroidectomy, which is Reflex Sympathetic pain. I have told 1 neruologist and 1 neurosurgeon about this and they dismissed me. Do my symptoms correlate to an RSD diagnosis? What is the best treatment and how do i get a Neurologist to believe me? I know it is very uncommon but i understand that the sympathetic nerves along with a possible immune system response could make this the most-likely diagnosis. Please help me.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Reflex sympathetic dystrophy (RSD) is also known as complex regional pain syndrome. Complex regional pain syndrome (CRPS) is a condition that is usually due to a soft tissue injury in many of the patients. Associated symptoms include abnormal skin color or temperature changes, abnormal sweating, and/or swelling of the affected extremity.  The exact pathophysiology is unclear. It is likely due to an abnormal reflex arc from the sympathetic nervous system modulated by cortical pain centers, e.g., brain, causing an increase in catecholamine (i.e., neurotransmitter) hypersensitivity. This latter statement is important because the emotional disturbance caused by the injury in many patients may be a precipitating factor in the pain syndrome.  The treatment is multi-factorial and should begin with neuropathic treatment such as neurontin, lyrica, or elavil.

Your symptoms do not seem to be RSD or CRPS at this time, but it is difficult without the ability to examine and get more history.

You should follow up with a pain specialist. These may be neurologists, psychiatristis or anesthesiologists.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[SarahE86]

Oh, also. I am not sure if this is relevant but it may be, my pain increases when it rains. Even if a high pressure system is moving in as long with the low pressure. It may not be of any importance but it sure is annoying and painful.