Lab Results?

[rondoo]

I had  Total Thyroidectomy 9/09 for Papillary Thyroid Cancer Follicular Variant.  I opted for dessicated thyroid hormone replacement after my RAI in nov. 09.  I have never felt well since.  Cancer had extended beyond the capsule but had no lymph node involvement.  Had negative whole body scan in May of 2010.  Goal for TSH suppression is <.05.  My lowest so far was .59.  I just got my results this week and my tsh is 13.09.  Thyroglobulin good at <0.2, Thyroglobulin Autoantibodies 31,  Anti-Thyroglobulun Antibodies 27, Thyroid Peroxidase Autoantibodies 43, Total T3  148, T4 4.6,  Free T4 0.7, Free T3 3.8.  My questions are  1) What do the Antibody tests mean after a TT and what is the reason for following them?  2)  If T3 and T4 are basically in range , why is TSH so elevated?  3)  How much do the Antibodies effect the Thyroglobulin level?  and 4)  Do these results mean that I had a Hashimotos or some type of Autoimmune thyroid disorder besides having cancer?   I would appreciate your response to any of these questions.   Also I have had chronic edema of lower extremities since my TT.  Could this still be Thyroid -related?     Thank you.

[naenae9155]

Please can you take the time to answer me back. Thank you  very much

The last sono was on 1/24/2011. I am hoarse all of the time now, throat sore, problem swollowing and can feel the buldge.  I have spasms in my neck and when this happens, a golf size knot comes up on the right side of my thyroid and gets really hard. It last for about 30 seconds.  Throat is dry.  I do not have any energy at all anymore.  I will sleep 14 hours and it feels like I have not slept for days.  The sono results are below.  Please give me your thoughts.  Thanks in advance.

The current study compared with the previous examination of 9/13/2010 shows the right lob to be 6.1x2.1x1.8cm.  There is a 0.8 cm hypoechoic complex nodule in the lower pole.

The left lobe of the gland measures 6.1x1.5x1.6cm. No discrete nodule or cyst in the left lobe is seen

The isthmus is 0.4cm with a 0.7 cm isoechoic nodule seen

Impression:  Enlarged gland with significant enlargement seen since the last study of 9/13/2010.  There is a single nodule in the right lobe and another nodule in the isthmus.

[naenae9155]

The last sono was on 1/24/2011. I am hoarse all of the time now, throat sore, problem swollowing and can feel the buldge.  I have spasms in my neck and when this happens, a golf size knot comes up on the right side of my thyroid and gets really hard. It last for about 30 seconds.  Throat is dry.  I do not have any energy at all anymore.  I will sleep 14 hours and it feels like I have not slept for days.  The sono results are below.  Please give me your thoughts.  Thanks in advance.

The current study compared with the previous examination of 9/13/2010 shows the right lob to be 6.1x2.1x1.8cm.  There is a 0.8 cm hypoechoic complex nodule in the lower pole.

The left lobe of the gland measures 6.1x1.5x1.6cm. No discrete nodule or cyst in the left lobe is seen

The isthmus is 0.4cm with a 0.7 cm isoechoic nodule seen

Impression:  Enlarged gland with significant enlargement seen since the last study of 9/13/2010.  There is a single nodule in the right lobe and another nodule in the isthmus.

[Mark Lupo, M.D.]

1) Tg antibodies must be looked at whenever Tg is measured as if the Tg antibodies are elevated, the Tg is not reliable.

2) TSH fluctuation may be due to inherent inconsistency with dessicated thyroid.  Would change to levothyroxine and discuss the target TSH with your endocrinologist -- may be higher than <0.05 at this point unless there is evidence of persistent/recurrent cancer.

3) see #1

4) Antibodies are thought indicate a history of autoimmune thyroid disease in addition to the cancer.  About 25% of thyroid CA patients have Tg antibodies.

edema may be related - TSH regulation would address this if related.