Best Medical Option for my brother

[raisebaigal]

Case History

After diagnosis of Papillary thyroid on 01-10-2010 (First Stage T4.N1.M0  Post operation Pathological Report),  on 19-10-2010 after TT on (12-10-2010) and RAI of 150 Mci, ultrasound report seems their was no node in Right side of neck. But after 6 month Follow nodes has been developed on the right side of neck. TT with Deep neck Dissection was done, while RAI expert was satisfied with the ...RAI dose and uptake level. Mean while on 03-04-2011 Thyroid profile test TSH result was .002 lowest , T3. T4 was normal. Can any body help me to understand this that after 6 month First interval visit what does this nodes in right side of neck means, while after TT and Neck Dissection ultrasound report showed nothing !. If nodes are there how we can say it is harmful or not. Whatever is this just needed to clear the point to understand mechanics of this development.

First Follow Up report

Here what I got thyroid fresh Profile result and ultrasound after 20 days LID and without taking thyroxin pills. Serum T3= .40 nmol/L while normal Range is (1.26-3.28) Serum T4 =1.28 ug/dl (6.4-13.3) Serum TSH > 100 ulU/ml. Serum FT4= .18 ng/dl while normal Range (.93-1.7), Serum Thyroglobin (Tg) =9.9 ng/ml while Normal range (below 55). Measuring Units may be different from the Pakistani hospitals in your own country. All above blood test were done through AKU-hospital with their defined measuring unites. Only issue left with my case is ultrasound shows and Whole body scan shows Nodes of Measuring .8 cm =( 8 Mille Meter) in one and small two other nodes in Right side of Neck. While in October 2010's W.B.S scan there was good uptake of the R.A.I on all Thyroid Tissue on right and Left side of Neck. Consequently on left side R.A.I works well and in June 2011 W.B.S scan there is no sign of uptake on left side of neck while on Right side of node measuring .8 cm( 8 MM) has show uptake. One more clarification is that this node neither shown in October-2010 ultrasound may miss at that time and developed later even after taking RAI.

(An exact word of ultra sound is " Impression: Status post thyroidectomy. No evidence of recurrence of disease in the region of thyroid bed. Chain of right Side enlarged cervical lymph nodes noted, the largest one measuring approx. . . .08 cm in short axis, no definite collection identified) while exact words or NM I-131 W.B.S conclusion. Whole Body I-131 (diagnostic scan) revealed evidence of residual (Left over) disease over thyroid bed & cervical nodes (predominantly (Largely) on the right side).

I am still not clear about wording of ultrasound report and NM I-131 as ultrasound says “No evidence of recurrence of disease in the region of thyroid bed” but Whole Body I-131 (diagnostic scan) revealed evidence of residual (Left over) disease over thyroid bed & cervical nodes (predominantly (Largely) on the right side). Which report finding we can trust on this point of time?

Dear friend our doctor Dr Najum Islam (Pediatric Endocrinologists at Aga Khan Hospital ) and Dr Masi Zaman (Radiation Oncologist at AKU) all have called Panel to find way out for this 8mm Node and report finding of NM I-131 W.B.S & ultrasound as on June 13, 2011. I request all of you if you can give your opinion or can discuss with your doctors regarding the case so that we can get better and secure way out for my brother of aged 15. which ever is best for his health and life we want to use that route. what about ethyl alcohol injections for thyroid in this case.

[raisebaigal]

Third Blood Test was done on 24-04-2011

[raisebaigal]

To: Doc for More information

Case History

After diagnosis of Papillary thyroid on 01-10-2010 (First Stage T4.N1.M0 after Post operation Pathological Report) on 19-10-2010 after TT on (12-10-2010) and RAI of 150 Mci, ultrasound report seems their was no node in Right side of neck. But after 6 month Follow nodes has been developed on the right side of neck. TT with Deep neck Dissection was done, while RAI expert was satisfied with the ...RAI dose and uptake level. Mean while on 03-04-2011 Thyroid profile test TSH result was .002 lowest , T3. T4 was normal. Can any body help me to understand this that after 6 month First interval visit what does this nodes in right side of neck means, while after TT and Neck Dissection ultrasound report showed nothing !. If nodes are there how we can say it is harmful or not. Whatever is this just needed to clear the point to understand mechanics of this development.

Thyroid Profile Results: First Blood Test on 09-12/2010

Serum T3 = Not Done    nmol/L   While Normal Range (1.26 - 3.28)
Serum T4 =Not Done ug/dl   While Normal Range (6.4 -13.3)
Serum TSH = 55.03 ulU/ml  (for age  21 to 54 years age Normal Range (.4-4.2)
Serum Thyroglobuline (Tg) =136.00 ng/ml  While Normal Range is below 55 ng/ml
Anti Thyroglobuline  =30.20 IU/ml  While Normal Range is below 34 IU/ml
Anti Thyroid  Peroxidase  =4.10 IU/ml  While Normal Range is below 12 IU/ml
Serum Calcium = 9.4 mg/dl  (8.4-10.2) mg/dl

Second  Blood Test on 23-02-2011
Serum T3 =1.64 nmol/L   While Normal Range (1.26 - 3.28)
Serum T4 =8.12 ug/dl   While Normal Range (6.4 -13.3)
Serum TSH = 17.30 ulU/ml  (for age  21 to 54 years age Normal Range (.4-4.2)

Third  Blood Test on 23-02-2011
Serum T3 =Not Done  nmol/L   While Normal Range (1.26 - 3.28)
Serum T4 =Not Done ug/dl   While Normal Range (6.4 -13.3)
Serum TSH = .002 ulU/ml  (for age  21 to 54 years age Normal Range (.4-4.2)


Fourth   Blood Test on 09-06-2011
Serum T3 =.40  nmol/L   While Normal Range (1.26 - 3.28)
Serum T4 =1.28  Done ug/dl   While Normal Range (6.4 -13.3)
Serum FT4= .18 ng/dl While Normal Range (.93 -1.7) ng/dl
Serum TSH = > 100  ulU/ml  (for age  21 to 54 years age Normal Range (.4-4.2)
Serum Thyroglobuline (Tg) =9.94 ng/mL  While Normal Range is below 55 ng/mL