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Dr. Redd
Dr. Redd, Board Certified Physician
Category: Medical
Satisfied Customers: 153
Experience:  Board Certified in Internal Medicine. I have been in full-time private practice for over 15 years.
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I have had recurring swollen lymph nodes in my neck for a year.

Resolved Question:

I have had recurring swollen lymph nodes in my neck for a year. I have a feeling of "fullness" in my neck and extreme fatigue. When I drink alcohol I have severe pain in the same area the swelling occurs. I have been to the doctor many times. They keep putting me off. I requested to be sent to an ENT specialist. Without feeling my neck, he told me it was my shampoo and to take aleve twice a day. I now have found a lump in my right breast which is the same side of the lymph issue. I went to the doctor and he suspects lymphoma. He said whatever it is it is progressing. I had an abdominal CT, blood tests, and a mammogram followed by ultrasound. I have not heard from the doctor and requested a copy of blood tests which is confusing. The CT was normal, no results from mammo. I am extremely concerned and the waiting is extremely difficult. Can you please help me? I don't know what to do next.
Submitted: 5 years ago.
Category: Medical
Expert:  Dr. Redd replied 5 years ago.
Customer
I can try to help you.
Could you tell me ...
How old are you?
What is your weight?
Can you remember what your weight was 6 months ago (Feb) and 1 year ago?
Are the lymph nodes swollen now?
To get it straight, did the ENT think your shampoo was irritating your neck?
What was abnormal in your bloodwork?
Did you have a chest xray or chest ct?
What medications do you take?
Thanks,
Dr. Redd


Customer: replied 5 years ago.
I am 38 years old- female
I weigh 151 pounds.
I weighed 157 in June of this year.
I weighed 172 in July of 2008.
Nodes are swollen now.
The ENT said sometimes shampoo can cause lymph swelling. No irritation on my neck.
No chest CT or Chest xray.
I am on levothyroxine for hypothyroid.
Blood work said- ALK PHOS was high, AST/GOT was low, %eosinophils is high, platelet count is high, all others are within normal range. Blood tests done are: comprehensive chem panel, iron saturation, CBC/auto diff, TSH, Ferritin
Expert:  Dr. Redd replied 5 years ago.
Customer
I just tried to respond and the computer lost my answer. Will try again ...

Have you been dieting over the past year?
Did you tell the ENT you were there because you felt you had swollen lymph nodes in your neck, or was it for another purpose? Hard to imagine them not examining your neck ...
Do you have the specific number results for these tests:
TSH
wbc, platelets, Hb (hemoglobin), exact percent of eosinophils
Alk Phos (and also, what is the normal range for your lab)
Do you have allergies?
Do you sweat more or less than a year ago, such as at night?
;What type of specialist said you might have lymphoma?
Why did they chose a CT of the abdomen and not a CT of the chest?
Thanks ...
Customer: replied 5 years ago.
I have not been "dieting" over the past year, just trying to make healthier food choices, but I do not deprive myself of anything. If that makes sense.
I was refferred to the ENT from my family doctor for the node swelling.
I am entering the test level with the normal range given in ( ).
TSH is .06
wbc is 7.6 range (4.5-11.0x10)
platelets 370 (130-350x10)
Hb Hemoglobin 15.1 (12.0-16.0 g/dl)
% Eosinophils 6 (0-5%)
ALK PHOS 167 (40-136 U/L)

I do have drenching night sweats. THe abdominal CT was to check for spleen enlargement. I have mild allergies- usually in the spring.
I have not been to a specialist other than the ENT, I cannot get a refferal. My doctor is a family physician. He has D.O. after his name if that helps any.
Expert:  Dr. Redd replied 5 years ago.
Customer

You have too much thyroid hormone. Your TSH is quite low, which means that your thyroid dose is too high. To try to explain, TSH is an acronym for "Thyroid Stimulating Hormone." Your pituitary gland in the brain makes TSH when it senses that your thyroid gland is not making enough hormone. So, when TSH rises (is high) it means that your thyroid hormone is not making enough hormone and your brain is trying to stimulate it to make more.

You are just the opposite. Your TSH is low. The normal range is usually 0.50 - 4.50, or fairly close to that. Most doctors try to adjust thyroid medicine to where the TSH lands between 1.0 and 2.5. With your TSH being low, that means that your brain is shutting down its production of TSH to below normal levels, because the brain senses too much thyroid hormone in your body.

Too much thyroid hormone (too high a dose of levothyroxine) can cause you to lose weight and to have sweats. It increases your metabolism to a rate that is not the best for your body. It can lead to a too-fast heart rate, or a heart arrhythmia called atrial fibrillation. Over the years, It can also cause excessive bone loss and lead to osteoporosis.

I think it is very unlikely that you have lymphoma. I don't know what to make of the swelling in your neck without examining it, but you may not be abnormal. Some people just have lymph nodes that happen to be larger than others, and that may be it. Some people have lymph nodes that swelled up with some prior viral infection and never returned to the normal size. Some people have nodules on their thyroid gland, called a multinodular goiter, causing their thyroid gland to feel nodular.   And some people just have fuller necks.

People with allergies tend to have higher eosinophil counts. Your eosinophils are not much beyond the normal range, so I don't see the count as a sign of anything worrisome. Same with your platelets. The alk phos is a little elevated, but sometimes it is elevated if people are overweight. It is something that as a doctor, I would watch, but not get shook up over quite yet.

I don't see any connection with the breast lump. I think it is separate. You will just have to wait on the mammogram result.

This is what I think is going on: You need your dose of levothyroxine lowered. That you are hyperthyroid could explain everything. I suggest you contact your family doctor tomorrow, and ask his nurse whether he can schedule you to see an endocrinologist (hormone specialist) to manage your thyroid levels. If seeing an endocrinologist would take too long, then ask your doctor to get you started on a lower dose of levothyroxine, now, but still see an endocrinologist for followup.

Best wishes,
Dr. Redd

Dr. Redd, Board Certified Physician
Category: Medical
Satisfied Customers: 153
Experience: Board Certified in Internal Medicine. I have been in full-time private practice for over 15 years.
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