Question: Hi Doctor,

I live in Toronto, Canada. I'm suffering from non-stop heavy strange sensation of pins & needles in the throat and sometimes in the whole right or left half neck completely disabling me/making me can’t lead normal life at all. The location of the sensation switches in between the right side, the middle side and the left of my throat/neck along the lining of larynx or the back of the tongue but it never stops. There are multiple factors leading to my current symptom, including hypersensitivity due to thyroidectomy in May 2014, very serious hypothyroidism/endocrine disorder after the surgery, reflux history after the surgery and viral infection of stomach flu etc. The symptom used to be well reduced for a whole year by talking valium/diazepam and I led normal & happy life for that year until the viral infection of a stomach flu triggered the symptom again about two years ago.

After seeing so many doctors of different specialties, trying various medications and treatment with failure, it is recently found by accident that the sleeping pill of "zopiclone" gave me significant relief from throat/neck symptom soon after taking it. The effect lasted for hours and I was able to function like a normal person during these hours. However, it soon becomes much less effective for zopiclone to give me symptom relief.

Combining various test results and what doctors said, my problem should be a neurological disorder that is not due to direct damage by thyroid surgery. It is highly doubted that the nerve endings along my larynx are irritated that need to calm down. To focus on problem solving to reduce my symptom so that I can function to some extent and further see doctors in the meanwhile & in the long run to make it clearer of my diagnosis, I am wondering why only diazepam and zopiclone worked so fast to relieve symptom while so many medications failed? Especially that diazepam used to well relieve me from the symptom for a whole year even when it was reduced to very low dosage and then stopped for months and I still had no symptom until the viral infection of a serious stomach flu triggered the symptom again.

Are there long-term medications with the mechanism similar to diazepam or zopiclone that I can try on a long term basis?

I learned that there is a medication named "quetiapine" as recommended by an experienced neurologist. This neurologist said that she has seen many similar cases as me and the hypersensitivity of the nerves give me the symptom with multiple factors as the reasons/triggers. She said that diazepam and zopiclone are easy to have tolerance and short-acting so that they are not solutions. While, she thinks that since my symptom can be temporarily well released by taking diazepam or zopiclone in the history, there should be other long-acting medications that can give me symptom relief. The difficulty is to find them. She asked me to try a medication named "quetiapine" saying that it can be used for a long term with the aim to reduce my symptom to the extent that I can lead normal life even though it may be impossible for me to get 100% symptom relief. She said that it takes time for quetiapine to function and it needs to reach enough dosage depending on different persons.

Besides, by consulting a neurosurgeon about my situation, he thinks that my issue should not be directly caused by nerve damage by thyroid surgery. His reason is that the discomfort location switches in the right, middle and left side of the inner throat and it should be at fixed location if there is nerve damage by surgery. Another reason is that my sensation is not sharp pain, but strange sensations of pins & needles and etc. that is very hard to describe. He suggested me to see the right neurologist who is familiar with medications. In fact, pain killers don't work for my symptom based on previous trial and experiences.

Based on the above, can you give me some advice on the most possible reason of my symptom? The underlying reasons why diazepam and zopiclone used to work well to give me symptom relief? Advice on the medication of quetiapine that I've just started to try? Any other medications or treatment that I should try?

My situation is rare and hard, and it often comes to no input when seeing many doctors/specialists in face. I know there can still a series of tests to be done to rule out those illnesses that are unlikely to happen or have nothing to do with this torturing symptom of mine. In fact I just hope that you can give me some meaningful input based on the information I provided. I've done my best to make it clear and complete and please feel free to ask me if you need to know any other information.

Thanks,
Joyce