What is globus?

The term globus comes from the latin meaning ‘ball’.

 

Globus sensation is the persistent sensation of a lump (or ball) in the throat where swallowing is found to be normal.

 

It may also be accompanied by a change in your voice. Some people describe it as a frog in the throat. Others feel like the throat is being constricted.

 

Why does globus happen?

Globus is a caused by a tightening of a muscle called the ‘cricopharyngeus muscle’. This sits around your oesophagus (gullet) and prevents food or fluids from coming back up into the mouth and throat. If this muscle becomes continually tight, globus symptoms may occur.

 

This muscle tightening can be caused by a number of different factors:

 

1. Acid reflux from stomach into throat

2. Stress

3. Surgery

4. Musculoskeletal tension

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Treatment:

Your Speech and Language Therapist (SLT) and ENT doctor will help you identify the causes for your symptoms. Your ENT doctor may prescribe you with an antacid medication if you have symptoms of reflux. Your SLT will give you some advice on looking after your throat and some exercises to aid relaxation of the muscles that have tightened in your throat.

 

With treatment, symptoms usually fully resolve.

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Things you can do to help:

 

• drink plenty of water

• inhale steam daily

• try to take time to relax regularly

• if you feel you have acid reflux, see your specialist

This is some advice on what to do or not to do while you are trying to improve your voice or throat condition and should be followed even after your voice or throat has improved. 

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Try to minimise strain on your voice by: 

Not shouting, whispering or singing

 

Avoid excessive talking

• over background noise

• on the telephone

• in dry, dusty or smoky atmospheres

• when tired, unwell or upset

 

Avoid coughing or throat clearing; sip cold water, suck boiled sweets or chew gum to relieve the tickle

 

Do not smoke and avoid alcoholic drinks

 

Avoiding taking:

• strong spicy foods

• dairy products

• caffeine based drinks e.g. tea/coffee/coke

• cough sweets

 

- Avoiding physical strain or lifting or moving of heavy objects

- Try to avoid eating late at night

- Avoid using strong detergents, washing powders, perfumes or aerosol sprays

 

It is also helpful to: 

- Drink plenty of fluids (water or juice are best) –at least 10 glasses throughout  the day

- Inhale steam daily

- Take time to relax and rest your voice

What is my thyroid gland?

 

The thyroid is one of the major and largest endocrine gland. Endocrine glands produce hormones (chemicals), which are important for various metabolism and development of our body. Thyroid gland is the sole source for production of Thyroid hormone. Thyroid hormone increases the basal metabolic rate of most cells, is required for bone growth and maturation of neurological tissue. It is also needed for normal production of breast milk (lactation) and is involved in protein, fat (stimulates breakdown), carbohydrate, and vitamin metabolism.

 

Where is my thyroid gland located?

 

The gland itself is located in front of the neck, just below the Adams apple. In normal individuals it may not be visible, but can be apparent in an individual with thin neck or occasionally during puberty or pregnancy. The gland has two main lobes situated on either side of the trachea (windpipe) with a small piece connecting the two (isthmus).Each lobe is pear shaped and measures about 2.5 to 4 cm in length, 1.5-2cm in width and 1-1.5 cm in thickness. The weight of the gland is quite variable and is normally in the range of 10-20gm

 

What does the thyroid gland do?

 

Thyroid gland produces thyroid hormones in different forms. Thyroid gland produces all of body’s T4 (about 80-90 mcg/d), but only 20% of body’s T3 (~8 mcg). 80% of T3 is produced by conversion of T4, mainly in liver and kidney, little in heart. Total production of T3 is about 32-35 mcg/day.

 

Thyroid hormone is synthesized from Iodine, which is normally found in our diet. The daily requirement of iodine is 150micgm/day. Although during pregnancy and lactation the requirement goes up to 200 micgm/day.

 

How is the secretion of thyroid gland controlled?

 

As in any other endocrine glands, the thyroid hormone secretion is under tight balance between the thyroid gland, the blood levels of thyroid hormones and the pituitary gland. Pituitary gland is the master gland that orchestrates (controls) the many other hormones. Hence the pituitary gland is the ‘that lies underneath your brain in your skull. Pituitary gland is located in the centre of the brain more or less behind the base of the nose. In addition there is complex interaction between all these hormones. Pituitary gland produces TSH (Thyroid Stimulating Hormone), which regulates the secretion of thyroid hormone from the thyroid gland. The pituitary gland is in turn controlled by hypothalamus, positioned just above the pituitary gland and also the level of thyroid hormones in the blood. The hypothalamus does this by secreting another substance known as TRH (Thyroid Releasing Hormone)

What are parathyroid glands?

 

Parathyroid glands are small glands situated close to the thyroid gland (Para + thyroid) but are not related to thyroid gland. Most individuals have four parathyroid glands, except in rare cases when one can have one less or more (occasionally situated at different location)

 

Where exactly are they located?

 

Parathyroid glands are in the neck behind the thyroid. Two on either side one at the upper end and lower end towards the back and outer aspect of each lobe of the thyroid gland. Normally the size and shape of a grain of rice, however, occasionally they can be as large as a pea and still be normal. Normal parathyroid glands are the color of spicy yellow mustard. They have a very rich blood supply

 

What do the parathyroid glands do?

 

Parathyroid glands make a hormone, called "Parathyroid Hormone" (Hormones are protein capable of causing distant cells in the body to react in a specific manner). Your doctor and the laboratory refer to them as “PTH” which is an abbreviate term for Parathyroid Hormone.

 

What does PTH or parathyroid hormone do?

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The sole purpose of the parathyroid glands is to regulate the calcium level in our bodies within a very narrow range so that the nervous and muscular systems can function properly. These glands can sense the level of calcium in the blood every minute and accordingly control the secretion of parathyroid hormones to control the calcium level.

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They also have an effect on phosphate level and activation of vitamin D in to active form

Why is Calcium so important?

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There are numerous elements in our body. Calcium is the most important minerals which are tightly regulated by complex mechanism and the normal level is critical to function of normal cell.

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These are key to – structure of cell, electrical energy for our nervous system and muscular system, clotting of blood, communicating between cells and hormones and strength to our skeletal system. Calcium is the element that allows the normal conduction of electrical currents along nerves--its how our nervous system works and how one nerve 'talks' to the next. Our entire brain works by fluxes of calcium into and out of the nerve cells. Calcium is also the primary element which causes muscles to contract.

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Hence one can understand why calcium is very important and has to be tightly regulated.

What is reflux?

Reflux is the backward flow of stomach contents and digestive acids back up into the food pipe and the throat.  This can cause throat irritation.

 

It is also known as laryngo-pharyngeal reflux or gastro-oesophageal reflux.

 

Symptoms of reflux:

• Feeling something stuck in the throat

• Hoarseness

• On going dry cough

• Frequent throat clearing

• Pain in the throat

• Bad/bitter/metallic taste in the mouth

 

Symptoms are often worse at night or after lying down and on waking up

 

How to reduce reflux?

• Reduce stress levels

• Avoid restrictive or tight clothing around the waist e.g avoid tight belts etc

• Try to observe the way your digestive system reacts to various foods.

•   Common foods which cause reflux are

           - Spicy, acidic, tomato based foods  [mexican,asian,italian]

           - Fast foods/fatty foods

           - Caffeinated drinks eg tea, coffee, soft drinks

           - Peppermint and chocolate 

 

It may be another type of food for you. See which foods irritate and try to avoid them  

 

Additional Advice:

• Eat meals several hours before bedtime.

• Eat small amounts of food

• Avoid bedtime snacks

 

Your GP or ENT doctor may prescribe an antacid medication to help with your symptoms or a specialist ear nose and throat surgeon.

Ultrasound of Neck and Thyroid

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This is a harmless, non invasive test for the neck lumps using sound waves. It helps to find out if the lump is actually arising from the thyroid gland or from a neck gland ( called a neck node). It also helps to characterise the lump eg - solid or cystic or both. In addition, it helps to see number of lumps, if one or both sides are affected and also to see if the lump has extending beyond the expected location. The other structures of the neck such as lymph nodes can also be seen and assessed.

 

Ultrasound guided Fine Needle Aspiration (FNA) / Ultrasound guided Biopsy

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Needle biopsy (called Fine Needle Aspiration or FNA) is done to get some cells from the lump to assess its nature. It is carried out using a small blood sample needle or sometimes a larger biopsy needle (called core biopsy). Most of the thyroid lumps are suitable for FNA. The procedure can be done with Ultrasound guidance, which helps to accurately locate the lump and guide the needle to the important areas.

 

It is almost like a blood test, except that it is done in the neck. It is a safe technique, and almost all patients will be able to continue about their normal business within 30 minutes or so after having the test. Very occasionally one may feel a bit of lasting discomfort, and rarely one may have a small bleed into the thyroid gland which can cause pain and discomfort for a few days.

What is Thyroxine (Thyroid Hormone)?

Thyroid hormone is synthesized in the follicles of thyroid gland and stored as a complex with another protein known as thyroglobulin. Once released from the gland, most (75%) of T4 is bound to thyroid binding globulin (TBG), with a small amount (15%) bound to other proteins. Almost all (99.7%) of T3 is bound to TBG.

Free hormone or the unbound hormone is the active hormone. 99.98% of T4 is bound, 99.7% of T3 is bound. T3 is 3-5 times more potent than T4.

 

What does my doctor mean by thyroid problem?

 

In certain individuals (because of various inciting factors like antibodies, inflammation, drugs etc), especially in those with a family history of thyroid related condition or other hormone conditions (like diabetes (mainly type 1, Addison’s disease etc) there is an increased likelihood of developing thyroid hormone imbalance.

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Thyroid over activity or under activity is diagnosed based on clinical symptoms, examination findings of your doctor and confirmed by blood test. In addition certain individuals present with swelling of the gland, pain or lump in front of the neck. Although majority of them are not cancerous certain lumps or swelling may have features of cancerous potential and can be picked up earlier by diagnostic tests.

 

What are the blood tests for thyroid?

 

Most commonly performed blood test is that for TSH. The modern assays are ultrasensitive and provide a fairly good understanding of your biochemical thyroid status; however certain deviation and aberration can occasionally be seen. In addition most Thyroidologist/ Endocrinologist will take in to consideration the free thyroid hormone levels for a complete evaluation.

 

Thyroid antibodies are abnormal proteins that may act as a stimulating or inhibiting protein to the thyroid gland, which can result in over activity or under activity. The measurement of these may help but do not directly help in treating these conditions but may help in nature of the cause.

 

What other tests are available for thyroid problems?

 

Thyroid ultrasound

Fine needle aspiration cytology

Radio-iodine uptake scan

MRI scan

Spirometry

What is a normal calcium level?

The human body contains approximately 1100 gm of calcium 99% of which is deposited in bones and teeth. In the blood they are either bound to protein, free or in complex with other substances. The levels of calcium in the blood range between 2.2 – 2.6 mmol/l (8.5- 10.5 mg/dL)

What happens if my calcium level is too high or too low?

A sudden drop in the calcium level (like after a successful parathyroid operation where the patient doesn't take their calcium pills for the first few days after the surgery) can cause patients to feel "fuzzy", "weird" or "confused like my brain isn't working correctly"

Too high a calcium level can make a person feel run down, cause them to sleep poorly, irritable than usual, and impair memory. In fact, the most common symptoms for patients with parathyroid disease are related to the brain, and include depression and lack of energy. Some individuals may feel fine with no symptoms and the abnormality is picked up on incidental blood test.

How is the calcium level regulated by parathyroid hormones?

Maintaining and regulating the Calcium level is quite complex. In addition to parathyroid hormones there are other factors which contribute to Calcium levels.
If the calcium levels go down a little bit, the parathyroid glands recognize it and make excess parathyroid hormone (PTH) which goes to the bones and takes some calcium out and puts it into the blood. When the calcium in the blood is high enough, then the parathyroids stop producing PTH temporarily.

What are the other factors that control Calcium level?

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In addition to PTH other factors that contribute to maintaining a tight level of calcium are dietary calcium intake and absorption from intestine, Vitamin D levels, kidney function, bone conditions and Calcitonin

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What are the diets rich in calcium?

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Dietary intake of calcium averages around 1000 mg/day and 1500 mg/ day in postmenopausal women.
The major sources of calcium are dairy products and calcium fortified drinks.
Milk (300mg/cup), Cheese (300mg/oz), Yogurt (300mg/cup), Fruit juice with calcium (300mg/cup)

 

What are diseases or conditions associated with parathyroid glands?

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The single major disease of parathyroid glands is over activity of one or more of the parathyroids which make too much parathyroid hormone causing a potentially serious calcium imbalance (too high calcium in the blood). This is called hyperparathyroidism Occasionally parathyroid gland may be absent or may not produce PTH resulting in hypoparathyroidism.

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Very rarely the blood supply to the parathyroid gland may be affected during operation for thyroid related condition. This can result in either a transient or very rarely permanent hypoparathyroidism.