Aa
New Labs, any feedback?
So, I got the results of my labs today and the good news is that my Tg went down from 1.0 to .8! In not so good news, my TSH went up (.73 from .51) and my T3 went down (101 from 135). No wonder I'm tired. Interesting that I've had a dosage increase and my TSH went up though...I'm probably going to get re-adjusted and I'm very encouraged by the small drop in my Tg, even though it's still detectable...
Here is something I found about scan negative/tg positive cases and the recommended course of action:
In conclusion, how should one manage the scan negative, thyroglobulin positive patient with no underlying reason to suspect either a false negative scan or a false positive serum Tg level? Schlumberger (1 and in this paper) would empirically treat with 100 mCi 131I any patient with a Tg level of more than 10 ng/mL while off levothyroxine, and would only repeat the 131I TBS every 2–5 yr when the Tg level is in the range of 1–10 ng/mL. Given clearly measurable Tg levels, I would encourage alternative imaging procedures. For papillary thyroid carcinoma with a propensity to regional recurrence, that could include ultrasound, CT, MRI, 99mTc-MIBI, or FDG-PET. For follicular thyroid cancer with its propensity for distant metastases (especially to bone and lung), 99mTc-tetrafosmin or 99mTc-HMDP or 201Tl could be employed. Identification of isolated distant lesions by these methods would allow earlier intervention by surgical excision or external radiotherapy, rather than delaying further treatment until a subsequent 131I TBS might become positive or until serum Tg levels might increase further as a result of further tumor growth. In patients with higher risk disease following early total thyroidectomy and high-dose radioiodine ablation, this approach should permit effective management until such time as more target-specific tumoricidal therapies become available.
In conclusion, how should one manage the scan negative, thyroglobulin positive patient with no underlying reason to suspect either a false negative scan or a false positive serum Tg level? Schlumberger (1 and in this paper) would empirically treat with 100 mCi 131I any patient with a Tg level of more than 10 ng/mL while off levothyroxine, and would only repeat the 131I TBS every 2–5 yr when the Tg level is in the range of 1–10 ng/mL. Given clearly measurable Tg levels, I would encourage alternative imaging procedures. For papillary thyroid carcinoma with a propensity to regional recurrence, that could include ultrasound, CT, MRI, 99mTc-MIBI, or FDG-PET. For follicular thyroid cancer with its propensity for distant metastases (especially to bone and lung), 99mTc-tetrafosmin or 99mTc-HMDP or 201Tl could be employed. Identification of isolated distant lesions by these methods would allow earlier intervention by surgical excision or external radiotherapy, rather than delaying further treatment until a subsequent 131I TBS might become positive or until serum Tg levels might increase further as a result of further tumor growth. In patients with higher risk disease following early total thyroidectomy and high-dose radioiodine ablation, this approach should permit effective management until such time as more target-specific tumoricidal therapies become available.
Just got back from my scan and it was completely clean. I will have my stimulated TSH/Tg labs run tomorrow and the follow up with my Endo on Monday. I hope he doesn't decide to just throw another dose of 131 at me and just monitors me to see if my Tg comes down. If my TSH went up and my Tg went down, I think that is a good sign. Of course I am no doctor :)
That's great news that your Tg went down. If your TSH level had gone down too, the Tg probably would have been even lower. I'm betting that once you are properly suppressed your Tg will be nearly if not totally undetectable.
Getting TSH regulated is a delicate balancing act. All sorts of things can come into the equation. Just keep working with your endo with trying to get just the right dose and be sure to be consistent about taking your meds at the same time each day.
Take care!
Amy
Papillary Thyroid Cancer
First diagnosed 1985
TT and 1st RAI 1985
2nd RAI 1986
Recurrence 2008
Central compartment dissection April 2008
RAI 175mCi July 2008
Current Tg 8.3 with 3 suspicious lymph nodes on recent ultrasound
Getting TSH regulated is a delicate balancing act. All sorts of things can come into the equation. Just keep working with your endo with trying to get just the right dose and be sure to be consistent about taking your meds at the same time each day.
Take care!
Amy
Papillary Thyroid Cancer
First diagnosed 1985
TT and 1st RAI 1985
2nd RAI 1986
Recurrence 2008
Central compartment dissection April 2008
RAI 175mCi July 2008
Current Tg 8.3 with 3 suspicious lymph nodes on recent ultrasound
The drop in your Tg is great news. Mine is at .3 seven months post RAI and I am hoping that it drops because if it doesn't my Dr wants me to do another round of RAI. I think the main thing though for you is that it is moving in the right direction . . .closer to 0. Congratulations, and good luck on your scan tomorrow
I don't know anything about Tg, but it has to be wonderful news that it dropped! I would think it means that there are still cells producing it, but not as many as before. Whatever you are doing is working. I found it very encouraging!
As for your TSH....I'm sure they'll get it adjusted. It's so cliched, but it just takes time. I'm on my 4th medication change since my TT. It s*cks, for lack of a better phrase, but I know they'll get it right eventually. I hope the same for you.
Keep me posted - I love that you got some good news on your Tg!!! =)
As for your TSH....I'm sure they'll get it adjusted. It's so cliched, but it just takes time. I'm on my 4th medication change since my TT. It s*cks, for lack of a better phrase, but I know they'll get it right eventually. I hope the same for you.
Keep me posted - I love that you got some good news on your Tg!!! =)
Totie: The problem is that I think he will want my TSH even lower since they try to suppress for Cancer management. This number is almost identical to what I was before I had my thyroid removed in April...
Any ThyCa people have anything to offer about the drop in my Tg 7 months post TT? The whole reason I am currently on LID and getting scanned tomorrow is because my Tg was at 1.0 since my TT and now it seems to be going down...has anyone had this before?
Any ThyCa people have anything to offer about the drop in my Tg 7 months post TT? The whole reason I am currently on LID and getting scanned tomorrow is because my Tg was at 1.0 since my TT and now it seems to be going down...has anyone had this before?
Your TSH looks great.
I don't anything about Tg. I had a low TSH as well .44 and my T3 low as well. The dr. changed my dosage and my TSH went up to 5.90, I was not happy. She did readjust my dosage again, but I do not go back for another 3 weeks.
I have been under medicated and over medicated for the last two yrs, so I understand your frustration....
I don't anything about Tg. I had a low TSH as well .44 and my T3 low as well. The dr. changed my dosage and my TSH went up to 5.90, I was not happy. She did readjust my dosage again, but I do not go back for another 3 weeks.
I have been under medicated and over medicated for the last two yrs, so I understand your frustration....
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