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Avatar universal

Tg, Tg Antibodies, Lymph Nodes

Hi Dr. Lupo,

I'd appreciate if you could answer my question.

I had a TT 1/07, RAI 3/07. I had papillary cancer, stage 3. My thyroid, as well as 10 lymph nodes, were removed during surgery and 9 of the 10 nodes proved to be cancerous.

My concern now is that  in Jan 08, my Tg level was 12 and Tg Antibodies was 152.

A biopsy I had last Nov revealed papillary cells in some lymph nodes in my neck.  My surgeon's recommenation was to delay surgery since he couldn't be sure he would be able to find
all the cancerous lymph nodes since some are very small, and he didn't want to do a radical lymphectomy ( I agree). So it's a kind of wait and see scenario.

I am anxious to move forward and find out what is really going on in my body.
I know the Tg level is not good, but also now is not a good indicator because of the antibodies.

What would your recommendation be? What are the best tests to reveal where and how much cancer I have. I am concerned about it spreading. Would a PET scan or WBS be appropriate - now that I'm 12+ months post TT? My endo is concened about the Tg level but how do we find out what's driving the high level.

Thank you in advance,
Best Regards.




6 Responses
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Avatar universal
Hi Dr. Lupo,

I'd like your opinion on my latest developments.

I had an ultrasound a few weeks ago which showed a cluster of lymph nodes, the largest of which measured 1.1cm.

My endocrinologist recommends surgery, but my surgeon does not.
My surgeon said without radical next dissection, he can't be sure he'd get all the positive nodes. So his recommendation is to repeat ultrasound in 6 months and see if the nodes have grown.

My surgeon also does not recommend radiation alone due to risks of additional radiation, and risk of saliva gland damage - and his belief is surgery would produce better outcomes anyway.

However, my endocrinologist recommends radiation!

So, you can see I'm stuck between the 2 doctors' recommendations.

Oh, as noted in previous post, Jan08  Tg was 12 but with TgAb of 152 - recent blood work was inconclusive for Tg.

I'd very much appreciate your advice. Do you think there is any reason for nuclear scan since the surgeon doesn't want to pursue
surgery at this time?

Sincere thanks in advance.
Helpful - 0
Avatar universal
Could it be that your thyroid med is not adequate?
Helpful - 0
Avatar universal
I am 3 months post TT ( papillary ca)...achey joints, malaise/fatigue have returned.  I"m trying to understand what happens to the feedback loop ( pituitary/tsh) after thyroidectomy.  I have my daily dose of TH.  What compensation does my body have for a needed increment during any given day?  Thank you.
Helpful - 0
Avatar universal
Hi Dr. Lupo,

I'd like your opinion on my latest developments.

I had an ultrasound a few weeks ago which showed a cluster of lymph nodes, the largest of which measured 1.1cm.

My endocrinologist recommends surgery, but my surgeon does not.
My surgeon said without radical next dissection, he can't be sure he'd get all the positive nodes. So his recommendation is to repeat ultrasound in 6 months and see if the nodes have grown.

My surgeon also does not recommend radiation alone due to risks of additional radiation, and risk of saliva gland damage - and his belief is surgery would produce better outcomes anyway.

However, my endocrinologist recommends radiation!

So, you can see I'm stuck between the 2 doctors' recommendations.

Oh, as noted in previous post, Jan08  Tg was 12 but with TgAb of 152 - recent blood work was inconclusive for Tg.

I'd very much appreciate your advice. Do you think there is any reason for nuclear scan since the surgeon doesn't want to pursue
surgery at this time?

Sincere thanks in advance.
Helpful - 0
Avatar universal
Dr. Lupo,

I can't thank you enough for your response.

This is the most valuable feedback that I've received. My doctor has not been responsive and is not addressing my concerns.

So ,sincere thanks. From your feedback, I feel I have a plan of action and am now going to take things into my own hands. It is my health and life, after all.

Best Regards,
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
The Tg level is high but somewhat difficult to interpret in the face of Tg Ab's.  The source is likely the neck nodes.  Usually we observe these until one or more is greater than 1cm in size -- then careful ultrasound lymph node mapping is done prior to surgery so that the surgeon can "clean-out" all the involved lymph node levels.  This is called a modified neck dissection and is a major surgery.

A PET scan may be of interest as a PET positive node is considered more aggressive - the protocol though is to usually have a negative WBS before going to PET.  But with a positive WBS that brings up the possibility of I-131 treatment -- which may help the nodes, but is not likely to cure them like surgery could.
Helpful - 0

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