Which Specialist Should I Consult for Thyroid Issues and Nerve Pain?

Which specialty should I see?

Hello Doctor: I am a 50-year-old patient with thyroid issues.
I underwent thyroid surgery about 20 years ago.
My current condition has relapsed for around ten years, and the examination results indicate a benign thyroid tumor, approximately the size of a chicken egg.
I have been under regular monitoring for the past ten years, although there has been slight growth.
I am currently having regular check-ups at National Cheng Kung University Hospital and taking a thyroid medication.
I am experiencing muscle and nerve discomfort.
Which specialist should I consult? The endocrinology department advised me to see a neurologist, but after examination, the neurologist found no issues and referred me back to endocrinology.
Both specialists have examined me and stated that the conditions are interrelated, yet all tests conducted have not revealed any problems.
I would appreciate some advice.
I am considering surgery, but the doctor mentioned that since I had surgery before, the color of the muscle and nerve tissue has become indistinguishable, making it difficult to identify during surgery, which raises the risk.
Is this statement accurate, and will the symptoms of discomfort and numbness resolve after surgery? In your opinion, should I proceed with the surgery or avoid it?

papa, 50~59 year old female. Ask Date: 2000/11/26

Dr. Lin Mingxing reply Family Medicine

Hello, there is an important matter that needs to be clarified: what specific areas are experiencing the soreness and numbness? If it is due to compression from a thyroid tumor (what is its size?), it may cause cervical spine compression, leading to soreness and numbness in the neck, shoulders, and upper limbs.
Additionally, abnormalities in the thyroid (such as hyperplasia) may sometimes require consideration of central nervous system issues (such as problems with pituitary secretion) to determine if there are any other neurological symptoms.
Regarding your inquiry about surgery, I encourage you to visit a family medicine specialist, who will be dedicated to providing you with the most accurate diagnosis.

Reply Date: 2000/11/26

More Info

When dealing with thyroid issues and nerve pain, it can be quite challenging to navigate the healthcare system, especially when specialists seem to send you back and forth without providing a clear solution. Based on your situation, it appears that you have a history of thyroid problems, specifically a benign thyroid tumor that has been monitored for about ten years. You also report experiencing nerve pain and muscle discomfort, which can be frustrating when both the endocrinologist and neurologist are unable to pinpoint the cause of your symptoms.

Firstly, it is essential to understand that thyroid conditions can sometimes have systemic effects on the body, including muscle and nerve function. Hypothyroidism, for instance, can lead to muscle weakness and pain, while hyperthyroidism can cause muscle wasting and other neuromuscular symptoms. Given that you have a history of thyroid surgery and ongoing issues, it is crucial to maintain regular follow-ups with an endocrinologist who specializes in thyroid disorders. They can help monitor the growth of the tumor and assess whether it is affecting your thyroid hormone levels, which could contribute to your symptoms.

Regarding your nerve pain and muscle discomfort, it might be beneficial to consult a pain management specialist or a rheumatologist. A pain management specialist can provide a comprehensive evaluation of your pain and may suggest treatments such as physical therapy, medications, or even interventional procedures to alleviate your symptoms. A rheumatologist can assess for any underlying autoimmune conditions that might be contributing to your muscle and nerve issues.

As for the surgical considerations, the statement made by your surgeon regarding the difficulty in distinguishing between muscle and nerve tissue due to changes in color is a valid concern. Surgical interventions in areas with previous surgeries can indeed be more complicated due to scar tissue and altered anatomy. The risk of complications may be higher, and the potential for nerve damage during a second surgery is a legitimate concern. It is crucial to weigh the risks and benefits of surgery carefully. If your symptoms are significantly impacting your quality of life and conservative management options have been exhausted, discussing the potential for surgery with a surgeon who specializes in thyroid surgery and has experience with reoperations may be the next step.

In summary, I recommend the following steps:
1. Continue Regular Follow-ups with Your Endocrinologist: Ensure that your thyroid condition is being monitored closely, especially since the tumor has been growing.

2. Consult a Pain Management Specialist: They can provide targeted therapies for your nerve pain and muscle discomfort.

3. Consider a Rheumatology Evaluation: This can help rule out any autoimmune conditions that may be contributing to your symptoms.

4. Discuss Surgical Options Thoroughly: If surgery is being considered, seek a second opinion from a surgeon experienced in reoperations for thyroid issues. Discuss the risks and benefits in detail.

5. Explore Non-Surgical Options: Before deciding on surgery, consider all non-invasive treatments available, including physical therapy, medications, and lifestyle modifications.

Navigating these health issues can be complex, but with a coordinated approach involving the right specialists, you can find a path that addresses both your thyroid and nerve pain concerns effectively.

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