Recurrent thyroid cancer

[amela321]

I was diagnosed 22 years ago with Papillary Thyroid Cancer.   Unfortunately, as I was only 20 at the time and naive about this sort of thing, I'm not sure what stage it was and the medical records are long gone.  Anyway, I recently had a TSH stimulated Tg level taken which came back as 23.0.  This lead to a neck ultrasound that showed "a solid-appearing hypoechoic lesion measuring 6 x 6mm that does not have the appearance of anormal lymph node and exhibits somewhat ill-defined margins and an irregular vascular pattern with some central calcification."  My research (and it's been extensive) has lead me to realize this is more than likely a recurrence of the cancer.  

I am scheduled for a TSH stimulated whole body scan, which I feel is appropriate, to see if there's  cancer anywhere else.  I'm wondering, though, what the next step after that should be.  Is it better to have surgery to remove what they've found (whether or not they find anything else) or if everything else is negative, should I just have another round (I had 2 rounds when the cancer was initially diagnosed) of RAI?  Should both things be done?  Surgery, then RAI regardless if the WBS turns up anything else?

Any insight, information, etc.... would be greatly appreciated.

[amela321]

Thank you very much.  That was pretty much my line of thinking, but I just wanted another opinion.  I appreciate your time.

[Fernando Roque, MD]

Hi.  You have an elevated thyroglobulin level and a suspicious looking neck lesion on ultrasound. What's the next thing to do? The TSH stimulated whole body radioiodine scan is appropriate to look for other possible sites of cancer.  If this turns out negative, a PET scan can be done to screen for additional cancer sites.  

After doing the scans, if there is proven localized recurrence, surgery can be done if the lesion is resectable. If the localized recurrence is unresectable, RAI combined with external beam RT can be given to those tumors which concentrate radioactive iodine. For those which do not concentrate I-131, external beam radiotherapy alone is appropriate.

If the scans are negative (both I-131 scan and PET) but the Tg level remains elevated, some doctors still recommend treatment with radioiodine therapy, but this recommendation is controversial.

Hope this clarifies things.