Thyroid pain
introduction
Thyroid pain is caused by irritation of the sensory nerves Superior larnyge nerve and Recurrent laryngeal nerveboth of which arise from the large and important vagus nerve. A sensitive pain nerve is triggered by various stimuli. This process is called in the technical language Nociception. The corresponding receptors are called Nociceptors and sit in practically every fabric.They are sensitive to different qualities: mechanical stimuli, extreme thermal stimuli (extreme heat and cold) and chemical stimuli (for example bell pepper heat).
They are also activated via inflammatory substances, which explains why inflamed areas are always painful. Inflammation of the thyroid gland can lead to pain as can manipulative interventions. The stimuli are then conducted into the brain via ascending pathways. Only then does the conscious perception arise, the pain.
The most feared cause of cancer, however, is not painful.
causes
Pain after thyroid surgery or a puncture
The thyroid gland is usually operated on when a suspicious lump needs to be removed or the thyroid gland has grown so large that it affects the surrounding structures.
Read more about this under Goiter symptoms
After each operation, there is rather mild and rarely severe pain in the respective operating area. However, these are not only due to irritation of the thyroid nerve, but also to the fact that other tissues had to be cut to reach the thyroid gland. Pain after an operation on the thyroid gland therefore also comes from the skin, the subcutaneous tissue and the connective tissue. Above all, it is mechanical irritation and inflammatory substances that irritate the nerves of the thyroid gland.
Post-operative pain (Pain after an operation) can be aggravated by psychological stress, personal perception and classification of painful experiences, inflammation in the operating area or insufficient administration of pain medication. As a rule, the pain medication Novalgin® (active ingredient: metamizole) is given after operations. It is a very potent pain reliever that is used against severe pain.
Persistent pain along with hoarseness and voice changes should be evaluated by a doctor.
The puncture is also one invasive (injurious) intervention, but the area of which is much smaller. There should be little pain. The most common reason for a thyroid biopsy is a suspicious lump. Then a fine needle puncture is usually performed.
Learn more at: Thyroid biopsy
Laryngitis
The thyroid is located under the larynx. A branch of (supplying the thyroid) Superior laryngeal nerve sensitively innervates the upper part of the larynx. Because of the close relationship between the two organs, a patient cannot say for sure whether the pain is coming from the thyroid gland or from the larynx.
A laryngitis (laryngitis, Epiglottitis) can have many causes, often associated with infections and colds, but also overload (voice and speech organs!). Laryngitis practically does not spread to the thyroid gland.
Read more about this under Laryngitis
unilateral pain
Said supplying nerve does not run in the middle of the body, but has a right and left counterpart. Therefore, it is theoretically possible for only one side to report pain. This can occur after an operation where only one side of the thyroid was removed. A random (idiopathic) Inflammation of the individual nerve is not yet known.
Hypothyroidism
Pain in hypothyroidism (Hypothyroidism) are very rare. The causes of hypofunction are congenital or acquired. Acquired causes are, for example, medication or surgery (here, of course, postoperative pain can occur again), autoimmunological processes (the immune system is directed against its own structures) or malfunctioning of certain brain areas that control thyroid function. The metabolic changes can cause pain in the legs, arms and chest area. These are due to changes in the skeletal and muscular area. They occur very rarely.
Read more about this under
- Symptoms of an underactive thyroid
- Acquired hypothyroidism
Thyroid nodules and scintigraphy
Lumps can be noticed in the palpation examination. A rough, painless lump should always be clarified quickly, as this is how thyroid cancer can express itself. As a rule, nodules are already visible on ultrasound, but only this can be of significance Scintigraphy judge.
The functional state of the thyroid tissue is examined with a scintigraphy. A low level radioactive substance (Technetium Tc-99m), which helps the thyroid gland to glow in different colors in the imaging. If an area does not or only slightly accumulates, one speaks of cold nodes. These are suspicious of malignancyi.e. a cancer should be excluded or proven below.
Read more about this under Cold lump on the thyroid gland
Hot nodes show an overfunction in a described area.
Read more about this under Hot lump on the thyroid gland
If the thyroid gland accumulates over a large area, it is probably a completely different thyroid disease, Graves' disease.
Read more about this under Graves disease
Warm nodules, which indicate an autonomy of the thyroid tissue, can be examined more closely with the hormone administration of T3 and T4. With negative feedback, they tell the brain that it shouldn't produce any more TSH (which stimulates the thyroid). If the warm nodes continue to glow warm, this is evidence that they are working separately from the brain. One then speaks of thyroid autonomy. This investigation is called Suppression scintigraphy.
If there is a cold lump, other things can also be responsible: cysts, inflammation, bleeding, scars or calcifications. The result is then a further examination, the biopsy (sampling).
Swelling of the thyroid gland
If the thyroid is swollen, it is called a goiter or goiter. The most common cause (90%) of a goiter is iodine deficiency, which is particularly prevalent in our latitudes (low-fish diet!). The iodine deficiency causes hyperplasia of the thyroid cells, i.e. an increase in the number of cells without an increase in cell size. This causes the entire thyroid to swell, but it does not affect the hormonal functions of the thyroid.
More rarely, it is a malfunction of the thyroid gland that leads to a goiter. For example, cysts, Graves disease (an overactive disease), a brain tumor (which produces too much TSH and secondary growth in the thyroid) or malignant diseases. These can be tumors in the thyroid gland itself or metastases (spreads) of other cancers.
A goiter has to become very large to make swallowing, breathing or other discomfort. Then an operation to relieve the strain is necessary. The iodine deficiency goiter is easy to cure with iodine therapy and is also showing a decline.
Read more about this under
- Thyroid enlargement
- Iodine deficiency
Hashimoto's thyroiditis
Hashimoto's thyroiditis is an inflammation of the thyroid gland that causes the immune system (autoimmune disease). Your symptoms are the same as those of normal hypofunction. Affected patients may rarely report a phase in which they had noticed a swelling in the throat or difficulty swallowing.
Read more about this under Hashimoto's thyroiditis
Concomitant symptoms
The thyroid produces vital hormones that increase your metabolism. In their target organs, they cause and increase the consumption of oxygen and energy Thermogenesis (Heat production).
In the case of congenital hypofunction, the newborns are only noticeable after birth, as they were previously also supplied by maternal hormones. Overall, they appear apathetic, drink less, are cool, have low muscle tension, and are constipated. Normal newborn jaundice (Neonatal icterus) can be extended for them. In the further course, if not treated, they show short stature (delayed skeletal development), mental retardation, brain damage and the skull plates close more slowly (fontanel closure). Signs such as shaggy hair, doughy skin and an enlarged tongue are clearly visible from the outside.
Read more about this under Symptoms of an underactive thyroid
Similar and other symptoms appear in adults. Affected people are generally less motivated and slowed down, they suffer from weight gain, anorexia and constipation, may experience a slow heartbeat and an intolerance to cold. The skin can be cool, dry, and swollen (like newborns) and have brittle hair. Edema (swelling) can occur in some parts of the body: on the shins, on the vocal cords (symptom of hoarseness and lumpy language) and on the heart. But edema of the subcutaneous tissue can also occur all over the body, called Myxedema. There is also rarely a thinning of the lateral parts of the eyebrows (together with the skin symptoms, this should not be confused with neurodermatitis). Women may not have menstrual periods.
Elderly patients may experience many of these symptoms at the same time, and doctors mistakenly diagnose them as dementia or depression.
Pain in your chest, arms, or legs
If you consider the functions of the thyroid hormones, you can see why a malfunction, among other things, Can cause pain in the muscular and skeletal tissues of the body. Underactive leads to muscle weakness, while overactive leads to an increased breakdown of protein in the muscle fibers. The latter can be painful.
The same applies to bone formation and breakdown, which is subject to a delicate balance of growth hormones.
These complaints rarely occur and are always regressive under therapy.
Chest pain can also result from muscular or skeletal breakdown processes, but should be alarming because of the involvement of the heart. As already described for the accompanying symptoms, edema of the heart muscle can occur. These can be proven by conventional heart-specific examinations and also declined by hormone therapy in the early stages.
Read more about this under Chest pain
Sore lymph nodes on the thyroid gland
The lymph is drained through the lymph node stations Noduli lymphatici thyrodei in the Nodi lymphatici cervicales anteriores profundi, continue about the Nodi lymphatici paratracheales. These are deep cervical lymph nodes and lymph nodes to the left and right of the windpipe. These are not the same ones that are often swollen in the upper neck area from infections or colds. Only a professional medical examiner can clearly identify the thyroid lymph nodes as such at the given magnification. They can be swollen infections that affect the throat or larynx. Painless, rough lymph nodes should be examined by a doctor to rule out cancer.
diagnosis
The diagnosis of pain is based on the detailed questioning of the patient. The easiest way to diagnose malfunction of the thyroid gland is to take a blood sample. The activity of thyroid hormones can be demonstrated in the blood. These are called T3 and T4 or free T3 and T4 (fT3, fT4).
Only the fT4 value is meaningful. He is degraded in all forms of underactive. In order to investigate the underlying cause of the hypofunction directly, one also determines another hormone. This is called TSH (Thyroid stimulating hormone or Thyrotropin).
It is increased in the case of hypothyroidism that has existed for a long time, as well as hypothyroidism whose problem lies in the thyroid gland itself (e.g. loss of function in Hashimoto's; primary hypothyroidism).
TSH is decreased in processes that are subject to malfunction in the brain. The affected brain areas are the Pituitary gland and the Hypothalamus. They are the brain's hormone production sites.
Read more about this under Thyroid levels
Treatment / therapy
The treatment is simple - the missing hormones are supplied from the outside. The dosage is adjusted depending on whether and how much residual function the thyroid gland still has. It is taken for life. Name of the preparation is L-thyroxine, this corresponds to the T4 of the body. Regularly (every six months) you should check whether the medication is correctly adjusted. This is done with the determination of TSH in the blood.
Read more about this under L-thyroxine
Duration and forecast
With good cooperation of the patient and regular monitoring, the patients have little or no disadvantages in life and in their health. Complications arise from increased or decreased consumption of L-thyroxine. Correct tablet intake should therefore be monitored in elderly or mentally retarded people.
