Cytomel after total thyroidectomy?

[KJ5854]

Dear Dr. Lupo,
I recently, 12 days ago, had a total thyroidectomy.  A small, 5mm, papilliary cancer with follicular variant was discovered.  Nothing in lymph nodes and they believe cancer stayed in thyroid.  However, because of my age and the follicular variant my surgeon is recommended RAI.  I'm find with that, but my question revolved around Cytomel which he gave to take until I have my RAI.  He prescribed two 25mcg pills pre day.  Just fyi, I've never taken any thyroid med before in my life.

My questions is this.  Should I start taking this even though I don't feel bad?  I don't seem to be experiencing any symptoms of not having a thyroid.  Or, should I go ahead and start taking this Cytomel as most likely I will start to expereience symptoms soon.  I've heard people have some side effects (sleeplessness, headaches, nauseau) taking this Cytomel.  

Please let me know what you think.
Thank you.

[Mark Lupo, M.D.]

Would see a thyroid specialist.  If this was an incidental 5mm follicular variant papillary thyroid cancer noted during surgery for an otherwise benign nodular thyroid, then there is no evidence that RAI is helpful.  Follicular variant has the same behavior as classic papillary.  A single focus less than 1.5cm (some say 2cm) without extension or lymph node involvement does not likely need I-131.  Furthermore, cytomel is used to prepare for withdrawal from thyroid hormone for RAI treatment -- the FDA recently approved thyrogen for RAI treatment which means patients stay on the levothyroxine the entire time.  I usually start levothyroxine after surgery then discuss the pros/cons of RAI with the patient after the pathology is reviewed by an expert at a university and if we use RAI, then we use thyrogen preparation and not cytomel withdrawal protocol.

Cytomel 25 2x/day is like taking 200mcg a day of synthroid -- it's a lot of medication that many people cannot tolerate.

[Mark Lupo, M.D.]

With no extension outside the thyroid, no lymph nodes, a single focus of a 5mm papillary cancer (follicular variant), and no blood vessel invasion -- the current guidelines state that RAI is not indicated.  Some patients still chose RAI for peace of mind though.

[dania73]

A related discussion, What should I do? was started.

[KJ5854]

Thank you so much for your response.  I am meeting this Wednesday with an endocronologist who does specialize in thyroid issues/cancer etc.  I'm eager to get her opinion on whether RAI is needed.

The 5mm papilliary cancer with follicular variant was the only cancer found and the path report says the lymph nodes were clear.  It also says blood vessel invasion was absent and that the tumor was limited to thyroid.    Do you feel RAI is necessary?  I'm 39 years old and I am slightly concerned that without RAI this thyroid cancer could show up later.

Thank you!