Common side effects of Tapazole include rash, itching, hives, abnormal hair loss, skin pigmentation, swelling, nausea, vomiting, heartburn, loss of taste, joint or muscle aches, numbness, and headache. Methimazole was introduced into use in 1954 and is still widely used for the temporary amelioration of hyperthyroidism in Graves disease, particularly in patients with mild or self-limited hyperthyroidism or who wish to avoid thyroidectomy or radiation therapy. Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. Product labeling at DailyMed, National Library of Medicine, NIH, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (MD). Stopped in Dec for oral surgery now (July). Cross-Sectional. 2019 Jan 19;15:65-69. doi: 10.1016/j.jcte.2019.01.001. It helps to keep in mind that these symptoms are temporary and should resolve within the year. Bad dreams Depression Difficulty thinking clearly Fatigue Feeling jumpy or nervous Irritability or becoming excited easily Rapid mood swings Shakiness Physical Symptoms Clammy skin Elevated blood pressure Headache Insomnia Loss of appetite Nausea and vomiting Paleness Rapid heart rate or palpitations Naltrexone is available with a prescription and can be taken as a daily pill or a monthly injection. What special dietary instructions should I follow? Tests for hepatitis A, B and C and autoantibodies were negative. You may report side effects to the FDA at 1-800-FDA-1088. At first, symptoms of withdrawal may feel like the flu. doi: 10.1046/j.1365-2265.1996.d01-1563.x. More serious side effects may include: Liver damage Yellow eyes or skin Severe abdominal pain/stomach pain Very dark-colored urine Nausea/vomiting that doesn't stop Otsuka F, Noh JY, Chino T, Shimizu T, Mukasa K, Ito K, Ito K, Taniyama M. Hepatotoxicity and cutaneous reactions after antithyroid drug administration. Took methimazole for 5 yrs, dropping it once after to to see on doc's orders. What side effects can this medication cause? The best way to cope with methadone withdrawal is to avoid skipping doses or trying to quit abruptly. Basal thyroid hypoechogenicity cannot be used as an index of relapse of GD. You are likely to experience withdrawal symptoms each time your dose is cut. Advertising revenue supports our not-for-profit mission. Papachristos DA, Huynh J, Grossman M, MacIsaac RJ. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Brent GA, Koenig RJ. Drug information provided by: IBM Micromedex. Prozac Withdrawal: Timeline, Symptoms, and Coping, Daily Tips for a Healthy Mind to Your Inbox, Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline, Methadone maintenance treatment. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Sweating and/or chills. Thyroid hypoechogenicity in GD at onset has been considered a prognostic index of relapse after medical treatment; moreover, thyroid hypoechogenicity is regularly observed in GD at the onset, but not in patients with 'burned-out' disease. It is often used in hyperthyroidism. Methimazole is available in generic forms and under the brand name of Tapazole as tablets of 5 and 10 mg. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Results of our real-world drug study have been referenced on 600+ medical publications, including The Lancet, Mayo Clinic Proceedings, and Nature. Shipp JC. Once they reach peak severity, your symptoms will begin to resolve. You should also talk to your doctors about your plans after giving birth. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports. Pregnancy affects the way your body metabolizes methadone, so your dose may need adjusting as your pregnancy advances. Naltrexone binds to the opioid receptors and acts like a blockade, preventing other opioids from binding to those same receptors. Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Geneva: World Health Organization. Give it some time. Do not double doses. A single copy of these materials may be reprinted for noncommercial personal use only. Livadas S, Xyrafis X, Economou F, Boutzios G, Christou M, Zerva A, Karachalios A, Palioura H, Palimeri S, Diamanti-Kandarakis E. Liver failure due to antithyroid drugs: report of a case and literature review. Both meds you're on take a little getting used to. If you drink alcohol while taking a beta-blocker and your blood pressure drops too much, you may experience the following symptoms: dizziness lightheadedness fainting, especially if you get up. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. AdultsAt first, 15 to 60 milligrams (mg) per day, given in 3 divided doses about every 8 hours. Isolation. Make sure you tell your doctor if you have any other medical problems, especially: Take this medicine only as directed by your doctor. Russo MV, Galanko JA, Shrestha R, Fried MW, Watkins P. Liver transplantation for acute liver failure from drug induced liver injury in the United States. Abnormal loss of hair. It is a commonly used drug in medication-assisted treatment (MAT) of opioid addiction. Stick to a structured sleep schedule. How Long Does Withdrawal From Suboxone Last? Neither thyroid hypoechogenicity score nor TRAb values evaluated in basal conditions, showed significant differences between patients remaining euthyroid and those who became again hyperthyroid. Mikhail NE. With a short-acting opioid, these withdrawal symptoms can be intense, but they typically peak within a couple of days and then begin to resolve. At the withdrawal evaluation a score < 2 and a TRAb value < 10 U/l were considered as normal. Kwon H, Kim WG, Jang EK, Kim M, Park S, Jeon MJ, Kim TY, Ryu JS, Shong YK, Kim WB. While opioids suppress breathing, however, the diarrhea drug can have the opposite effect disrupting the . Longitudinal prospective study of previously untreated patients with GD. Measurements: Call your doctor for medical advice about side effects. Methadone is a medication that treats chronic pain and the symptoms of opioid withdrawal. Feeling like you have a bad flu, vomiting, diarrhea, sweating, and insomnia are all common. Chitturi S, Farrell GC. The amount of medicine that you take depends on the strength of the medicine. However, it is possible that your child will be born with an opioid dependence, which means they will need to detox. Everyones experience getting off methadone is different. Your symptoms may start off mild and become more severe over the course of a few days. Many people find support at local 12-step meetings, such as Narcotics Anonymous. Common acute withdrawal symptoms include: Methadone withdrawal symptoms vary from mild to moderate. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. An altered perception of time. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Patients with opioid dependence show withdrawal symptoms when the drug is discontinued. When using methadone, you may experience . Some cases have features of autoimmunity or immunoallergic hepatitis and have been treated with corticosteroids, but without proven evidence of benefit. Finally, social support is a key aspect of relapse prevention. Epub 2016 Apr 25. 3. Proper addiction treatment takes a multifaceted approach that combines medication management with psychotherapy and social support. 3rd ed. Sato H, Minagawa M, Sasaki N, Sugihara S, Kazukawa I, Minamitani K, Wataki K, et al. A normal thyroid hypoechogenicity score at withdrawal of MMI had a higher specificity (0.95) and sensitivity (0.59) with respect to TRAb values (0.86 and 0.53, respectively) for the prediction of the relapse of hyperthyroidism at the 24th month. It does not cause birth defects or pregnancy complications. The usual dose in adults is 15 to 60 mg daily in three divided doses until the patient is euthyroid, followed by a maintenance dose of 5 to 15 mg daily. If you need help planning when to take your medicine, check with your doctor or pharmacist. are not due to another medical condition, drug use, or discontinuation) is found to be associated with 2,197 drugs and 1,551 conditions by eHealthMe. After recovery from the liver injury, her hyperthyroidism was treated successfully with radioactive iodine. Methimazole is an antithyroid medicine. Mamianetti A, Muoz A, Ronchetti RD, Maccione E, Poggi U, Mugnolo R, et al. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Lucemyra is a new medication; it's similar to clonidine and recently approved by theFDA to treat the symptoms of opioid withdrawal. Tapering methadone means gradually taking smaller doses over the course of several weeks or months. Kwon H, Lee SH, Kim SE, Lee JH, Jee YK, Kang HR, Park BJ, Park JW, Hong CS. Four days is nothing when it comes to thyroid meds. Unusual weakness or fatigue, fever, headache, skin rash, muscle or joint pain, loss of appetite, pain, tingling, or numbness in the hands or feet. low blood counts due to bone marrow failure. Clinical review: Clinical utility of TSH receptor antibodies. Werner MC, Romaldini JH, Bromberg N, Werner RS, Farah CS. Recovery is usually rapid once methimazole is stopped, and the first priority should be immediate discontinuation of antithyroid therapy at the first sign of clinically apparent liver disease. Clinical spectrum and therapeutic approach to hepatocellular injury in patients with hyperthyroidism. Store it at room temperature and away from excess heat and moisture (not in the bathroom). The maintenance dose is 0.2 mg per kg of body weight per day. Unauthorized use of these marks is strictly prohibited. low levels of granulocytes, a type of white blood cell. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). A cohort study. Takiing Armour (thyroid hormone replacement) has seemed to cause your hyperthyroidism. methimazole withdrawal and she was fully recovered in 4 days with no more signs of arthritis or arthralgia, so we discontinued Goosebumps or gooseflesh. National Institute on Drug Abuse and Addiction. American Society for Addiction Medicine. Methimazole is used to treat hyperthyroidism, a condition that occurs when the thyroid gland produces too much thyroid hormone. Swelling. Although not all of these side effects may occur, if they do occur they may need medical attention. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule at evenly spaced, 8-hour intervals. . Verywell Mind's content is for informational and educational purposes only. Insomnia or inability to sleep. Yoshihara A, Noh J, Yamaguchi T, Ohye H, Sato S, Sekiya K, Kosuga Y, et al. Stomach cramps or stomach pain. These side effects come from organ damage. ChildrenDose is based on body weight and must be determined by your doctor. These could be symptoms of a serious liver problem. Antithyroid drugs. Could the anxiety be stemming from you actually still needing the methimazole? Hopefully, never more. If you relapse with heroin or prescription painkillers, you will be at risk of a life-threatening overdose. tell your doctor and pharmacist if you are allergic to methimazol, lactose, or any other drugs. Please enable it to take advantage of the complete set of features! Ask your healthcare professional how you should dispose of any medicine you do not use. Treating Opioid Use Disorder During Pregnancy. Likelihood score: A (well known but rare cause of clinically apparent liver injury). This may sound depressing, but it doesn't have to be. What special precautions should I follow? After that, reductions should slow to 5mg per week. 432 Objectives To evaluate whether 3-day withdrawal of methimazole (MMI) prior to radioactive iodine therapy (RAI) is adequate in Graves' disease with adjunctive MMI treatment. In the whole group, the thyroid hypoechogenicity score was significantly lower at the withdrawal than in basal conditions (1.1 +/- 1.1 vs 2 +/- 0.8; P < 0.0001); it was significantly lower in patients in remission (P < 0.001), but not in those who relapsed. eCollection 2021. Worsening of constipation or GI issues Worsening memory function Increased pain And other symptoms of hypothyroidism These side effects usually mimic the side effects of hypothyroidism, because if you stop taking your medication your body will not be able to produce it naturally for some time. MeSH Bjrnsson ES, Bergmann OM, Bjrnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. He is the medical director at Alcohol Recovery Medicine. Instead, the best way to dispose of your medication is through a medicine take-back program. Methimazole should not be used during pregnancy or breast-feeding. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Methimazole (meth im' a zole), which is also known as thiamazole, is a thioamide and a thyroid hormone antagonist which acts by inhibiting the incorporation of iodine into tyrosyl residues of thyroglobulin and, thus, lowering thyroid hormone levels. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. Careers. tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially anticoagulants ('blood thinners') such as warfarin (Coumadin), beta blockers such as propranolol (Inderal), diabetes medications, digoxin (Lanoxin), theophylline (Theobid, Theo-Dur), and vitamins. Yang J, Zhong J, Zhou LZ, Hong T, Xiao XH, Wen GB. Yao JD, Gross JB Jr, Ludwig J, Purnell DC. Gallelli L, Staltari O, Palleria C, De Sarro G, Ferraro M. Hepatotoxicity induced by methimazole in a previously healthy patient. After you detox, your brain is operating with depleted stores of neurotransmitters. The patient had several produce neuromuscular symptoms that sometimes relapses due to non-compliance with her thyrostatic resemble each other (weakness and fatigue). Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. If you are currently using methadone or other opioids, it is best to continue with methadone until the end of your pregnancy. One last warning: Relapse is common among opioid users. Copyright, 2023. Avoid contact sports or other situations where bruising or injury could occur. Hackmon R, Blichowski M, Koren G. The safety of methimazole and propylthiouracil in pregnancy: a systematic review. In some instances, certain formulations of methadone may . Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Di Gregorio C, Ghini F, Rivasi F. Granulomatous hepatitis in a patient receiving methimazole. This site complies with the HONcode standard for trustworthy health information: verify here. If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. The symptoms went away and I enjoyed a medication-free pregnancy. Blood and urine tests may be needed to check for unwanted effects. If you are thinking about quitting, talk with a doctor about the pros and cons. Martinez-Lopez JI, Greenberg SE, Kling RR. In case of overdose, call the poison control helpline at 1-800-222-1222. Lung diseaseUse with caution. Common Methimazole side effects: Drug ineffective: 348 reports Hyperthyroidism (over activity of the thyroid gland): 336 reports Fatigue (feeling of tiredness): 320 reports Weakness: 271 reports Agranulocytosis (a deficiency of granulocytes in the blood, causing increased vulnerability to infection): 262 reports Headache (pain in head): 252 reports Graves' disease is an autoimmune disease that damages the thyroid gland. Propranolol therapy was restarted but methimazole was held. Mayo Clinic does not endorse any of the third party products and services advertised. [18] Agranulocytosis or aplastic anemia can also occur in hours to days. pain or discomfort in the chest, upper stomach, or throat. Indeed, more than half of patients with untreated hyperthyroidism have serum enzyme abnormalities (usually less than 5 times the upper limit of the normal range) and a small proportion are jaundiced and present with cholestatic hepatitis. Rare instances of prolonged cholestasis have been described, but no instance of vanishing bile duct syndrome. J Clin Endocrinol Metab. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Relapse rates among people with opioid use disorders are very high. 9 These symptoms can last a few weeks. Methimazole has been associated with transient, asymptomatic elevations in serum aminotransferase levels, typically during the first 3 months after starting during high dose, induction therapy. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. Different individuals may respond to medication in different ways. A. Research shows that roughly 3 in 4 people who complete opioid detoxification relapse within 2 to 3 years. Actual Study Start Date : December 23, 2017. When postoperative patients have adequate analgesia without serious side effects, encouraging patients to turn, cough, and breathe deeply is appropriate. Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Thyroid hypoechogenicity score (assessed by the same observer with the same equipment) was graded as: 0 absent; 1 mild; 2 moderate; 3 marked. Akmal A, Kung J. Propylthiouracil, and methimazole, and carbimazole-related hepatotoxicity. These meds don't work instantaneously, like antibiotics, etc. The American Society of Health-System Pharmacists, 4500 East-West Highway, Suite 900, Bethesda, Maryland. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding: Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. A burning, numbness, or tingling feeling that is not normal. Methimazole is an antithyroid medication which is now considered the first line agent for medical therapy of hyperthyroidism and Graves disease. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. The mechanism by which methimazole causes acute liver injury is unknown, but is likely due to an immunological reaction to a metabolic product of its metabolism. If your loved one is trying to recover from opioid addiction, you may want to consider a support group for friends and family, such asNar-Anon. An official website of the United States government. * Approximation only. In several instances, patients with methimazole induced liver injury have been switched to propylthiouracil without evidence of recurrence, but in at least one case, recurrent jaundice appeared. Symptoms include: Intense cravings for fentanyl; Chills or goosebumps . Sometimes one dose reduction is harder than the others and uncomfortable withdrawal symptoms occur. The acute (short-term) symptoms should disappear within two weeks. Detoxing from methadone is a great step, but it doesnt mean that youve beaten your addiction. heartburn. This content does not have an English version. Shen C, Zhao CY, Liu F, Wang YD, Yu J. Acute-on-chronic liver failure due to thiamazole in a patient with hyperthyroidism and trilogy of Fallot: case report. Yet many hypo sufferers complain of it as well. The initial dose is in the range 20 mg to 60 mg, taken as two to three divided doses. Clipboard, Search History, and several other advanced features are temporarily unavailable. Here in this paper, we report a 31-year-old case admitted with symptoms of hyperthyroidism that was then diagnosed with Grave's disease (GD) and underwent treatments with a low dosage of methimazole (10 mg/day). In these cases, your doctor may want to change the dose, or other precautions may be necessary. These symptoms are most common in long-term opioid abusers. If you notice any other effects, check with your healthcare professional. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Symptoms occurring after RAI therapy were evaluated by a questionnaire administrated to each patient 1 month after radioiodine therapy. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. The role of propylthiouracil in the management of Graves disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings, feeling of constant movement of self or surroundings, general feeling of discomfort, illness, or weakness, sores, ulcers, or white spots on the lips or in the mouth, swelling of the face, feet, or lower legs, swollen, painful, or tender lymph glands in the neck, armpit, or groin, pain or discomfort in the chest, upper stomach, or throat. Cappelli C, Gandossi E, Castellano M, Pizzocaro C, Agosti B, Delbarba A, Pirola I, De Martino E, Rosei EA. decreased sense of taste. If your dose is different, do not change it unless your doctor tells you to do so. The presence of hyperthyroidism may play a role in worsening liver function, and temporary management with beta-blockers or other approaches may be necessary even during the course of the acute liver injury. toxic multinodular goiter, subacute thyroiditis, etc.). A case of methimazole-induced acute hepatic failure in a patient with chronic hepatitis B carrier. Becker CE, Gorden P, Robbins J. Knowing the odds will help you understand the value of ongoing treatment. It is not unusual for people with opioid use disorders to go on and off methadone over the course of several months or years. Low thyroid levels (hypothyroidism)unusual weakness or fatigue, increased sensitivity to cold, constipation, hair loss, dry skin, weight gain, feelings of depression. Doctors prescribe it for two reasonsthe first is to give opioid addicts a safe, long-term option for relapse prevention, the second to treat stubborn cases of severe chronic pain. Use an effective form of birth control to keep from getting pregnant. Content is reviewed before publication and upon substantial updates. Feeling like you have a bad flu, vomiting, diarrhea, sweating, and insomnia are all common. Abramavicius S, Velickiene D, Kadusevicius E. Methimazole-induced liver injury overshadowed by methylprednisolone pulse therapy: Case report. A rare case of methimazole-induced cholestatic jaundice in an elderly man of Asian ethnicity with hyperthyroidism: A case report. Rapid heart rate and palpitations. Portions of this document last updated: Feb. 01, 2023. Do not take a double dose to make up for a missed one. Steroid nasal sprays do not usually cause any significant side effects if used correctly and at normal doses. 3. Andersen SL, Olsen J, Wu CS, Laurberg P. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. Fischer MG, Nayer HR, Miller A. Methimazole-induced jaundice. In RIT, the thyroid gland tissue is shrunk or destroyed. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of methimazole in children. In general, a handful of common physical withdrawal symptoms include: 4. Zhang M, Zhou H, He R, Di F, Yang L, Yang T. Steroids for the treatment of methimazole-induced severe cholestatic jaundice in a 74-year-old woman with type 2 diabetes. How Long Does Withdrawal From Methadone Last? These side effects may go away during treatment as your body adjusts to the medicine. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. official website and that any information you provide is encrypted Call your doctor for medical advice about side effects. Ways to manage: Doing some physical activity can help shake loose your jumpiness. Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Check with your doctor right away if you have constipation, a depressed mood, dry skin and hair, feeling cold, hair loss hoarseness or husky voice, muscle cramps and stiffness, slowed heartbeat, weight gain, or unusual tiredness or weakness. Do not keep outdated medicine or medicine no longer needed. Woeber KA. Methimazole Recruiting Phase 4 Trials for Drug Withdrawal Symptoms / Graves' Disease / Drug Relapse / Treatments Treatment. By Corinne OKeefe Osborn It can take up to six months for your brain to return to normal. muscle pain, cramps, or stiffness. Philadelphia: Lippincott, 1999, pp. 2013 Jun;98(6):2247-55. doi: 10.1210/jc.2012-4309. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. All rights reserved. Heidari R, Niknahad H, Jamshidzadeh A, Abdoli N. Factors affecting drug-induced liver injury: antithyroid drugs as instances. We are surprised that your doctor prescribed atenolol as a first-line treatment for . It is also important information to carry with you in case of emergencies. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Rare complications of methimazole (<1%) include agranulocytosis, aplastic anemia, nephritis and hepatitis. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings, feeling of constant movement of self or surroundings, general feeling of discomfort, illness, or weakness, sores, ulcers, or white spots on the lips or in the mouth, swelling of the face, feet, or lower legs, swollen, painful, or tender lymph glands in the neck, armpit, or groin, pain or discomfort in the chest, upper stomach, or throat.