Thyroid Nodules, Neck/Throat Pain/Flushing, Night Sweats

[Sanddabber]

I'll start by saying that I am a 42 yr old mother of three (19,11, and 9).  For the past 5 years, beginning in Fall 2010, I have been experiencing horrible NIGHT SWEATS.  My OB/GYN checked my hormones but did not find anything out of the ordinary.  I literally would wake up shivering (and still do) because my pajamas and sheets are soaked.  My doctor at the time suspected thyroid problems and checked my Free T4 and TSH levels.  Those results were:

Free T4 = 0.75 (range: 0.75 to 1.54)
TSH = 1.3 (range: 0.5 to 6.0)

She sent me for a THYROID ULTRASOUND.  That doctor said I had several small THYROID NODULES.  I wish I could remember more about size, etc, but my memory is failing me (yet another strange symptom I am dealing with: MEMORY LOSS!).  Nothing more was done about the nodules and I never went back because they (doctors) didn't seem to think it was abnormal, I guess?

After that, I was having reproductive/female issues, and that seemed to be more of a concern than the night sweats.  Or at least that's what my doctors grabbed on to.  In 2013, at age 40, I had a partial HYSTERECTOMY due to fibroids (I was also super anemic).  The doctor had to remove my left ovary because it had so many adhesions from endometriosis.  So I was only left with my right ovary and my cervix (only because the doctor said it was "glued" to my bowels -again, because of the adhesions).  I seriously thought maybe my night sweats would be "cured" by this, but no such thing!

I now believe that maybe my night sweats could be due to THYROID problems!  The reason I believe this is because for the last several months, I have been having horrible NECK/THROAT PAIN.  It feels like there is a buildup of pressure shooting into my ears, along with a tight, squeezing sensation from my chin down to my collar bone.  My neck feels FULL, if that makes sense.  The only relief I can get is from an ice pack around my throat.  I've tried NSAIDS, but they help very little or not at all.

The ice pack also helps with the HOT FLASHES in the face/neck that have been occurring for about one month now.

Here's another strange thing... I was recently (2 months ago) diagnosed with SLEEP APNEA!  I am 5'2" and 127 lbs, so I definitely don't fit the overweight category that is a risk factor.  But I was waking up choking, as well as being so sleepy during the day that I was falling asleep at red lights.  I am scheduled to get a CPAP in the near future, but honestly, I think that the reason I wake up choking and not breathing is because there is something in my neck/throat area that is pressing on my airway.  I can't get in to see the ENT until Sep 16.

Another strange thing that has been going on is that I have SCRATCHY EYES.  I told my ophthalmologist last year that it felt like I could feel my eyeballs moving, and that didn't seem normal to me.  Shouldn't an eyeball just move freely?  Lately they've been irritated and feel like they have eyelashes stuck in them.  But there are no eyelashes to be found.

Long story, but I finally have an appointment with my regular doctor this coming Monday.  What questions should I ask regarding my thyroid function?  I'm going to see if I can get blood work done and maybe another ultrasound.  Anything else?  I am miserable!  I have a one hour commute to work in both directions, and I don't know how much longer I can hold up with minimal sleep.  I've been super edgy and cranky too - probably due to not sleeping.

Any help/comments/suggestions would be greatly appreciated!

[gimel]

With those symptoms and TSH, you need further testing.  As a start, to determine the possibility of being hyperthyroid due to Graves' Disease, you should also test for Free T4 and Free T3 (not the same as Total T4 andTotal T3), along with TSI (thyroid stimulating immunoglobulin).  

[Ad34562]

I have  terrible memory loss.  The short term that is.  I can remember things that I do for couple of years etc.  But I forget names locations I don't feel pain or happiness I'm numb despite having still quite high libido.

Tsh resulted 0 zero!  Even below the acceptable scale

I had excessive night sweats

I still have right side head pain occasionally

My head hurts during exercise

I have shortness of breath often

Excessive tiredness.  I can simply wake up being tired already and can't remember the last time I got a good sleep.  

Mri resulted nothing

[gimel]

Those symptoms can be either hyper or hypo.  Note these symptoms from a very long list of hypo symptoms.  


Body Temperature:

Cold extremities
Cold sweats
Night sweats
Heat intolerance
Cold intolerance
Internal shivering
Hypothermia
Cold hands
Clammy palms
Cold feet
Excessive perspiration
Little perspiration
Low basal body temperature (below 97.8 degrees Fahrenheit)

As for the pain, fullness and choking feeling you should make sure the doctor does an ultrasound of the thyroid gland to see if there are nodules, or is swollen/inflamed.

[Sanddabber]

Wow!  Thank you gimel.  That is a very thorough response!

I had never heard of Central Hypothyroidism before, and I thought my symptoms more closely aligned with HYPERthyroidism.  Especially because I've been running hot and sweaty lately with the facial flushes.

What about the pain, fullness, and choking feeling in my throat/neck area?  I couldn't figure out how this could be related to CH after reading up on it.

I will be sure to mention this to my doctor on Monday, and I'll let you know what the outcome/blood tests reveal.

Until then, a big thanks from me to you!

[gimel]

With all those symptoms, it is incredible that your doctor looked at the Free T4 result at .75, the very bottom of the range, and decided that you did not have a thyroid problem.  Even though your TSH was well within range, has your doctor never heard of central hypothyroidism?  Central hypothyroidism is a dysfunction in the hypothalamus/pituitary system resulting in TSH well within range, but accompanying low levels of Free T4 and Free T3 and hypothyroid symptoms.  

We very seldom hear from members with a Free T4 level that is actually that low.  Due to the erroneous method used to establish the ranges for Free T4 and Free T3, the ranges are far too broad to be functional across their entire breadth.  Essentially anything in the lower half should be suspect and a reason for further evaluation.  In the words of a good thyroid doctor, "The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH results.  You can find all the symptoms you mentioned on a list of symptoms related to being hypothyroid, including sleep apnea.  You can also get some good insight from this link written by the good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

So at your appointment I suggest that you give a copy of the link to your doctor and mention that it is clear that you have central hypothyroidism and you need to be tested for Free T3, along with Free T3 and TSH.  Since hypo patients are so frequently low in the range for Vitamin D, B`12 and ferritin you should also request those as well.  If the doctor resists you should insist on it and don't take no for an answer.  Those tests will be a good start to further clarifying your status and showing the need for thyroid meds.  

I also suggest that you ask the doctor to read the copy of the link and decide if he is going to be willing to treat clinically, as described.  Also ask if he is willing to prescribe T3 meds, when necessary.    If either answer is no, then you will need to find a good thyroid doctor that will do so.  

When you have the test results, please post them, along with reference ranges shown on the lab report and we will be glad to help interpret and advise further.  If necessary we will also help find a good thyroid doctor.