Goiter.

[himmel]

Hi, my wife has had a slight swelling on the side of her neck for over a year, I've googled this and have come to the conclusion it could

a Goiter on the thyroid gland, she is reluctant to see a Doctor, any suggestions would be grateful, ie Government hospital, we are 

Lamplaimat, Burriram area.  Thanks.

[fredwiggy]

I had a swelling in a lymph node, had a biopsy done, just from a strep throat. This might help.......https://www.healthline.com/health/lymph-node-swollen-for-years-not-cancer

[Sheryl]

Having lasted a year, even if it is a lymph node it is unlikely to  be due to a throat infection.

 

It could be a number of things, all requiring medical evaluation and treatment....and none of which will go away on their own, though most are treatable. 

 

A doctor can quickly determine after physical examination and palpation whether it is an enlarged thyroid, a thyroid mass, an enlarged lymph node, or some other sort of mass. Additional tests may include blood tests, Xray and maybe a fine needle aspiration biopsy.

 

Assuming your wife is listed in a tabian ban in Lamplaimat, in order to do this under the free government system she has to go first to Lamplaimat Hospital. Make sure she tells them it has been there for a year. 

 

They may need to at some point refer her to a higher level hospital,   probably Buriram Hospital which is a regional level facility. She needs a referral letter from Lamplaimat Hospital to go there  otherwise have to pay out of pocket.

 

There are various ways of short-cutting things if necessary but first at least find out if it is thyroid or lymph node.

 

Your main problem is her reluctance to see a doctor.  She may fear it is cancer and assume that  if so,  it is fatal and thus want to delay knowing. In fact, there are many possibilities other than cancer. And for that matter, thyroid cancer is completely curable if caught and treated early. 

 

Get her to Lamplaimat Hospital and once you know if it is thyroid or lymph node etc  get back in touch with me. 

 

 

[Sheryl]

A post completely unrelated to thread content has been removed. 

[rwill]

Definitely get her to a doctor.

[ignore it]

Among the Asians I've known here in Thailand and in Vietnam there is a resistance to seeing a doctor for preventive care and diagnostic testing.

 

If something is broken or bleeding they have no hesitance, but for a lump or an ache they just live with it till the pain gets too much.

 

A Vietnamese friend of 30 years lived with an ache  for months and months until the pain became too much.  He finally got around to going to a doctor and  discovered he had stage 4 pancreatic cancer, and died shortly thereafter.

 

I had a heck of a time to get Mrs. Ignore It to go for an annual health screen, but after blood testing, a slightly elevated uric acid has her monitoring her chicken intake like a hawk.  Yet a sniffle or twinge will find her gobbling  traditional herbs, powders and pills.

 

Granted it may be the class of folks I like to hang around with or marry.

 

Just saying..

[himmel]

21 hours ago, Sheryl said:

Having lasted a year, even if it is a lymph node it is unlikely to  be due to a throat infection.

 

It could be a number of things, all requiring medical evaluation and treatment....and none of which will go away on their own, though most are treatable. 

 

A doctor can quickly determine after physical examination and palpation whether it is an enlarged thyroid, a thyroid mass, an enlarged lymph node, or some other sort of mass. Additional tests may include blood tests, Xray and maybe a fine needle aspiration biopsy.

 

Assuming your wife is listed in a tabian ban in Lamplaimat, in order to do this under the free government system she has to go first to Lamplaimat Hospital. Make sure she tells them it has been there for a year. 

 

They may need to at some point refer her to a higher level hospital,   probably Buriram Hospital which is a regional level facility. She needs a referral letter from Lamplaimat Hospital to go there  otherwise have to pay out of pocket.

 

There are various ways of short-cutting things if necessary but first at least find out if it is thyroid or lymph node.

 

Your main problem is her reluctance to see a doctor.  She may fear it is cancer and assume that  if so,  it is fatal and thus want to delay knowing. In fact, there are many possibilities other than cancer. And for that matter, thyroid cancer is completely curable if caught and treated early. 

 

Get her to Lamplaimat Hospital and once you know if it is thyroid or lymph node etc  get back in touch with me. 

 

 

 

[himmel]

Sheryl ,Thanks for your quick response, after reading it to my wife she feels more assured, and we will be going

to Lamplaimat hospital next week.  Thanks 

[Lacessit]

It may also be a lipoma, which is quite harmless. I have had one for years.

 

The OP won't know what it is without a doctor's examination.

[Mike Lister]

One of the key tests to tell if it is a goiter is an ultrasound exam, which is non-invasive, painless and inexpensive. A biopsy of the thyroid may seem daunting but is actually totally painless and quick.....I've had both several times and have had my thyroid removed completely, which also is not a big deal. 

[john donson]

check thyroid in blood FIRST 

 

before sticking a needle in a possible tumor

[himmel]

Quick update, went to Lamplaimat Hospital yesterday, after waiting 3.5 hours to see the Doctor she could not diagnose with a blood test, but we would have to wait 2-3 hours for the result, we have a appointment for the 3rd July for the result of the test. 

[Sheryl]

1 hour ago, himmel said:

Quick update, went to Lamplaimat Hospital yesterday, after waiting 3.5 hours to see the Doctor she could not diagnose with a blood test, but we would have to wait 2-3 hours for the result, we have a appointment for the 3rd July for the result of the test. 

Did the  doctor indicate if yhe enlargement  is on the thyroid or a lymph node? 

[himmel]

23 hours ago, Sheryl said:

Did the  doctor indicate if yhe enlargement  is on the thyroid or a lymph node? 

Yes she did, and that it was on the thyroid. 

[Sheryl]

43 minutes ago, himmel said:

Yes she did, and that it was on the thyroid. 

 

That is good. And blood test (thyroid panel) is indeed correct next step. All sounds good.

 

At some point will may need an ultrasound of the thyroid, they may need to refer her for that. 

 

Does the swelling interfere eith swallowing etc?

[LS24]

I don't want to clog up the thread, but it is so good to know that Sheryl gives her time and expertise here.

[Mike Lister]

2 hours ago, LS24 said:

I don't want to clog up the thread, but it is so good to know that Sheryl gives her time and expertise here.

I went through this process last year so perhaps some aspects of my experience may help? Sheryl remains however the expert on these things so you should continue to be guided by her.

 

In my case, the thyroid panel blood tests confirmed that something was amiss. My TSH number was very low whereas my T4 level was high, my thyroid was producing excess hormone so I was hyperthyroid. I already knew my thyroid was enlarged because I could feel it, especially in my neck, the question was, why.

 

The ultrasound exam revealed an enlarged thyroid but the exam didn't show exactly how enlarged it was. The doctor who did the exam said it didn't look like a cancerous thyroid but he may well say that to everyone, I don't know. The biopsy was the next step and as said previously, this is painless and quick, it helps that it's ultrasound guided in order to zero in on the right location. 

 

Despite three different biopsies, all three came back inconclusive, these things are not always black and white so it was necessary to consult the risk tables to compare the cell types that were found, with the chances that cancerous cells existed somewhere. In my case, there was a 48% chance, which made the decision how to proceed even harder. I was given the choice of sending the sample to Europe to undergo more advanced testing but that would have required time. A partial removal of the thyroid, to reduce the goiter, would require a second op, if cancer was found in the section that was removed. The presence of scar tissue from the first op would complicated that.

 

Eventually I consulted with two different Endocrinologists and a surgeon, all of whom leaned towards total removal, so that was what I chose. As it turns out, no cancerous cells were found but total removal was justified based on the size alone, which wasn't fully indicated by the ultrasound exam.

[himmel]

6 hours ago, Sheryl said:

 

That is good. And blood test (thyroid panel) is indeed correct next step. All sounds good.

 

At some point will may need an ultrasound of the thyroid, they may need to refer her for that. 

 

Does the swelling interfere eith swallowing etc?

She says not really, but she can feel there's something there. 

[himmel]

On 6/28/2024 at 12:17 PM, Sheryl said:

 

That is good. And blood test (thyroid panel) is indeed correct next step. All sounds good.

 

At some point will may need an ultrasound of the thyroid, they may need to refer her for that. 

 

Does the swelling interfere eith swallowing etc?

Went for the result of the blood test today, Doc said no abnormality's show, wife said she mentioned Goiter, my wife also has a slight yellowing of her eyes, so Doc made an appointment for two weeks time for further blood tests, on the Thyroid, Liver, and Kidneys.  

[Sheryl]

16 minutes ago, himmel said:

Went for the result of the blood test today, Doc said no abnormality's show, wife said she mentioned Goiter, my wife also has a slight yellowing of her eyes, so Doc made an appointment for two weeks time for further blood tests, on the Thyroid, Liver, and Kidneys.  

This is concerning.  And I am not comfortable with 2 week delay. Also seems strange that 2 week delay yo make a blood test. Frankly I think they should have already  referred her up the system.

 

Would you be willing/able to travel to Khon Kaen and/or go to a private hospital in Korat? Just to jump start things and get a diagnosis.

[himmel]

On 7/3/2024 at 12:26 PM, Sheryl said:

This is concerning.  And I am not comfortable with 2 week delay. Also seems strange that 2 week delay yo make a blood test. Frankly I think they should have already  referred her up the system.

 

Would you be willing/able to travel to Khon Kaen and/or go to a private hospital in Korat? Just to jump start things and get a diagnosis.

I apricate your concern, it is a little confusing but we will stick the system for now, It was a different   Doc this time. As for going private we would want to know the cost in writing before we would consider It.

[PPMMUU]

Did the doctor prescribe any medicine? Two weeks and a blood test sound a lot like a follow-up for thyroid function after initiating thyroid medication. It is not unheard of for a doctor to find an abnormal lab test, explain everything to the patient, and the patient doesn’t remember much, assuming it’s normal. If you choose to go to another hospital, it would be best to ask for the laboratory results and bring all the medication, if any, with you.

[Mike Lister]

Yellowing of the eyes points towards jaundice, a two week wait hardly seems appropriate.

 

A private hospital consultation with an endocrinologist is likely to cost around 1,000 baht plus tests (in the North).

 

Blood tests for liver panel, thyroid, renal, say 1.5k or 2k baht tops.

 

An ultrasound of the thyroid should be no more than 1,500 baht.

 

 

 

 

[Sheryl]

41 minutes ago, himmel said:

I apricate your concern, it is a little confusing but we will stick the system for now, It was a different   Doc this time. As for going private we would want to know the cost in writing before we would consider It.

I was not suggesting treatment at a private hospital, just getting diagnosis there to bring back to local hospital to speed things up a bit (since they seem to be proceeding at a crawl).  Many people have done this with success.

 

See @Mike Lister post re costs of diagnostic work. Which, in a private hospital, can all be usually done in one visit.

 

The jaundice is a bad sign. So are the normal thyroid tests (in benign thyroid diseases, thyroid  hormone panel  will usually be abnormal)

[Sheryl]

31 minutes ago, PPMMUU said:

Did the doctor prescribe any medicine? Two weeks and a blood test sound a lot like a follow-up for thyroid function after initiating thyroid medication. It is not unheard of for a doctor to find an abnormal lab test, explain everything to the patient, and the patient doesn’t remember much, assuming it’s normal. If you choose to go to another hospital, it would be best to ask for the laboratory results and bring all the medication, if any, with you.

 

The thyroid panel was apparently normal so no thyroid meds would have been given, and a higher index of suspicion for malignancy.

 

And she now has jaundice.

 

Mass was present (that she knew of) for a year.

[Mike Lister]

Our experience of Government hospitals is very mixed, diagnosis does not seem to be a strength but treatment can be. At my urging, my wife uses the University Hospital for diagnosis because it is fast and usually accurate, at a low cost, she then uses Government Social Security Hospitals for any significant treatment. We recently contracted covid, my wife went to the gov. Hospital and I went to the University Hospital. One hour later I had a confirmed covid diagnosis and anti-virals, five hours later my wife was told she had a cold and was given vitamins, she wasn't even tested for covid! 

 

If the thyroid panel results are normal you will need to look elsewhere, a head and neck surgeon would be appropriate. If the doctor your wife saw was an endocrinologist (I'm betting not), that doctor seems not to understand the significance of the findings (or lack of). It would behoove your wife to do as Sheryl suggests and fast track the diagnosis via a private hospital. They will be able to refer her back to the Government Hospital for treatment and potentially fast track the entire process.

[himmel]

On 7/3/2024 at 12:26 PM, Sheryl said:

This is concerning.  And I am not comfortable with 2 week delay. Also seems strange that 2 week delay yo make a blood test. Frankly I think they should have already  referred her up the system.

 

Would you be willing/able to travel to Khon Kaen and/or go to a private hospital in Korat? Just to jump start things and get a diagnosis.

Ok after reading all the reply's and given a rough idea of the cost, we didn't know one could go to a private and get referred back to a gov hospital, with the Doc at the gov hospital not losing face, Khon Kaen is to far, we are willing to go to Korat, although my wife is worried now I've read all reply's to her, because after going to Lampliamat hospital and being told there were no abnormality's she is thinking the worst now, She wasn't given any medication, We wait for your reply as to the next move, so the tests would be for the Thyroid, Liver, and Kidneys, can this all be done in one day. Thanks all for your reply's. 

[Mike Lister]

I will leave this for sheryl who is the acknowledged expert.

[Sheryl]

9 hours ago, himmel said:

Ok after reading all the reply's and given a rough idea of the cost, we didn't know one could go to a private and get referred back to a gov hospital, with the Doc at the gov hospital not losing face, Khon Kaen is to far, we are willing to go to Korat, although my wife is worried now I've read all reply's to her, because after going to Lampliamat hospital and being told there were no abnormality's she is thinking the worst now, She wasn't given any medication, We wait for your reply as to the next move, so the tests would be for the Thyroid, Liver, and Kidneys, can this all be done in one day. Thanks all for your reply's. 

 

There would be blood tests, probably an ultrasound (thyroid and maybe liver) and possibly a fine needle biopsy of the thyroid. At a private hospital usually possible to do all in one day though there would be a wait of  few days for biopsy results. Biopsy cost would be additional to what poster above mentioned but if they can do it, and do it at once, go for it.

 

Lamplaimat Hospital does not have the capacity to diagnose and manage her and seems to be dragging their feet on referring her up the chain.

 

You have several options as follows:

 

Buriram Ram hospital has one endocrinologist. Good chance she is also the endocrinologist at Buriram government hospital to which you  probably will (should have already) be referred

 

1.  https://www.buriram-ram.co.th/services/คลินิกโรคเบาหวานและต่อ/

 

2. Bangkok Hospital Korat has 3 endocrinologists as follows:

 

https://www.bkh.co.th/main/2024/05/นพ-ชูเกียรติ-สมจิต/

https://www.bkh.co.th/main/2022/02/พญ-รุ่งนภา-ลออธนกุล/

https://www.bkh.co.th/main/2022/02/พญ-กนกอร-เรืองศิลปานันท์/

 

As mentioned before, bring all records with you (especially blood test results). Once you have gotten a diagnosis at one of the above hospitals take all those records with you back to Lamplaimat and request that they refer you to a hospital with capacity to treat.

[Sheryl]

9 minutes ago, Sheryl said:

 

There would be blood tests, probably an ultrasound (thyroid and maybe liver) and possibly a fine needle biopsy of the thyroid. At a private hospital usually possible to do all in one day though there would be a wait of  few days for biopsy results. Biopsy cost would be additional to what poster above mentioned but if they can do it, and do it at once, go for it.

 

Lamplaimat Hospital does not have the capacity to diagnose and manage her and seems to be dragging their feet on referring her up the chain.

 

You have several options as follows:

 

Buriram Ram hospital has one endocrinologist. Good chance she is also the endocrinologist at Buriram government hospital to which you  probably will (should have already) be referred

 

1.  https://www.buriram-ram.co.th/services/คลินิกโรคเบาหวานและต่อ/

 

2. Bangkok Hospital Korat has 3 endocrinologists as follows:

 

https://www.bkh.co.th/main/2024/05/นพ-ชูเกียรติ-สมจิต/

https://www.bkh.co.th/main/2022/02/พญ-รุ่งนภา-ลออธนกุล/

https://www.bkh.co.th/main/2022/02/พญ-กนกอร-เรืองศิลปานันท์/

 

As mentioned before, bring all records with you (especially blood test results). Once you have gotten a diagnosis at one of the above hospitals take all those records with you back to Lamplaimat and request that they refer you to a hospital with capacity to treat.

 

Addendum: I have verified that the doctor listed at Buriram Ram, Preeyapat Chattieng, is one of the endocrinologists at Buriram hospital. It would therefore be strategic to consult her, as she may be able to help facilitate later treatment at Buriram Hospital (regional government hospital) and referral from Lamplaimat.