Is an elevated thyroglobulin level always cancer?

[osfmom]

I had a partial thyroidectomy (right lobe and isthmus) without ablation 8 years ago for a Hurthle cell adenoma.   I've been on Armour thyroid (120) for several years now and feeling pretty good, not great though.  Recently I moved and had to find a new doctor for my prescriptions.  When he palpated my neck, he said there was tissue that had grown back.  After doing an ultrasound to confirm and a WBS, I was told my thyroglobulin was high (184 on 6/6 and then 134 on 6/8) and therefore I needed to see a surgeon to see if it can be removed again and then ablated or just ablated.  The tissue and nodules are too small to biopsy.  Is there any other reason why my thyroglubulin could be elevated other than thyroid cancer?  I don't like having a cancer diagnosis without any evidence other than blood work.  BTW, the pathology report from my first surgery also found "microscopic focus of papillary carcinoma, 2mm maximal size" and was not staged.  The surgeon (chief of surgery at a large medical center) said I did NOT have cancer, as did my subsequent endocrinologist.  

[Mark Lupo, M.D.]

You still have a left lobe.  Normal thyroid makes Tg -- this is not specific for cancer in this setting.  Also, Armour (pig thyroid) may have Tg.
Would change to levothyroxine and get a second opinion before considering surgery or RAI.  Good neck ultrasound is the key here to identify any abnormal lymph nodes or suspicious nodules on the left.
A 2mm papillary has very low risk overall - be careful not to be over-treated!

[osfmom]

My current endocrinologist thought I should have HAD an ablation 8 years ago after the partial thyroidectomy (regardless that it was a 2mm subclinical papillary carcinoma).  At my last appointment he said I had to see an ENT surgeon to see if the surgeon could remove the regrowth before ablation or just have the regrowth ablated, base on cancer markers. I then met with an ENT surgeon in Atlanta who said "have it out asap".  I don't have another appointment with my endocrinologist until Sept.  I guess I will wait 6 months to re-evaluate as per the Tampa ENT surgeon who wants to watch the regrowth and nodule, since they are small.  I just hope there are no further Hurthle cell growths.

[Mark Lupo, M.D.]

Perhaps the first step would be to regroup with your endocrinologist and asked about why ablation was recommended for a micro-papillary thyroid cancer so that that you might better understand his/her thought process.

[osfmom]

Is it possible to get in to see you for a second opinion without a referral?  I don't want my current endocrinologist to think I am questioning his recommendation...but I want another opinion.  I have all my records with me.  I have left a message with your office.  The answering machine said your office accepts new patients only with referrals.  The ENT surgeon I went to (to see if he could remove the regrowth and nodule) said it was too small and wants to watch it for 6 months.  Or should I go back to my endocrinologist and question his previous recommendation of ablation and ask to go on Synthroid (both of which I don't want to do).

[osfmom]

Thank you.  That's what I was thinking.  I'll probably be calling your office this week to make an appointment.  Lucky you.   :)