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Pregnant post thyroidectomy
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Pregnant post thyroidectomy

I hope someone can help clarify my recent lab results for me.  I'm in panic mode.  We were trying for a baby early 2010 and had to stop when I found out I had papilary carcinoma of the thyroid.  I had a total thyroidectomy 5/2010 followed by RAI and removal of another thyroid tumor on my left ovary along with the ovary itself.  The second tumor was not malignant but it was thyroid so it was determined that I had Struma Ovari.  I had another dose or RAI and once my levels became acceptable, my Endo gave us permission to try for a baby again.  Thank God my right ovary was still working and I conceived on Dec 30th and am now 7 weeks pregnant and due Sept 21, 2012.  I just picked up my lab results to take to my doctor later this week and I'm terrified by what I see. Results are below:

Vit D - 21.3
FreeT3 - 362.9
Free T4 - 1.46
Thyroglobulin Autoantibodies - 40.7

I have been feeling very fatigued and tired, kind of how I felt following my surgery but I'm not sure if it's due to the thyroid levels or the pregnancy. This is my first pregnancy so I'm not sure what to expect and worry is overtaking me.   I am also very worried about the thyroglobulin level.  With it being 40.7, is that an indicator that the cancer is back?  I'm currently taking synthroid 200.  Thank you for your assistance.
Tags: post thyroidectomy pregnancy
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The most important lab would be a TSH which should be In the low normal range during pregnancy.  The thyroglobulin antibody level is not predictive in of itself, but the trend in antibody level over time is helpful in assessing the thyroid cancer status.

Regarding the struma ovarii, it is sometimes difficult to make a diagnosis of normal versus malignant thyroid tissue in this setting.  I imagine the specimen was sent for expert second opinion to confirm that was benign.

Your vitamin D level is a little bit low, you may want to discuss supplementation with your physician.
5 Comments
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Avatar_f_tn
I'm so happy for you to be pregnancy post thyroidectomy. I have my baby plans on hold as I have been diagnosed with nodules, waiting to see what the specialist thinks of what I have. I'm so anxious.
How did you find out that you had cancer?
hope it all goes well.
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Avatar_f_tn
Thank you very much for you valued opinion.   I completely forgot to post my TSH which is .03 so it appears that's good.

The throid tumor on my ovary was not sent for a second opinion.  Since it was last year, I'd assume it's too late for that now.  It was discovered on my diagnostic scan after my large dose of 150 RAI.  It was glowing like a giant ball.  According to the radiologist, he discounted it the first diagnostic scan I had before the RAI as bladder content.  This was frustrating to learn but I was glad he admitted it.  Due to the rarity of Struma Ovarii I suppose it would be understandable to assume that.  The put me through 4 seperate scans that day at 2 different hospitals and even cathaderized me before making the final determination so in the end, they did do the proper testing.  If only they had done that the first time, it would have caused less stress.  I'm only hoping it hasn't grown back but since they removed my entire thyroid and my entire left ovary and felopian tube I'm hoping that's not the case.  I'd assume after the abby is born I will likely undergo another diagnostic scan.  At least I hope so.  Having Struma Ovarii is stresfull because nobody knows really what to do with me since they've only seen it in their medical books.  I'm starting to feel like I'm alone in this.  You seem to know more than anyone I've come across so far.

As for the Vit D....I've been consistantly low for YEARS now.  The last test was 17.  I get prescription Vit D 50,000 weekly for a month and then they take me off of it.  It's frustrating since it seems I need it consistantly since I'm always lower than the average person and we all know that your average person is always low as it is.  I am post gastric bypass since 2000 which I'm sure contributes, but I do take my multi vitamins (prenatal for the last year).  I'm starting to worry about the long term damage being at level 20 or less can cause.  My body always hurts, like I'm bruised everywhere and I have been diagnosed with Ehlers-Danlos III but I wonder if the Vit D contributes.

Anyhow, thank you again for your advice.  I wish you had an office in Rhode Island.  :-)

S
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Avatar_f_tn
Thank you for your comment.  You are in the same situation I was in so I know it can be stressful.  The god news is that most cases of nodules are benign and nothing to worry about so it's most likely that you fall in that catagory.  If your nodules are big enough, which can be determined by ultrasound of your neck, the next step if to get a biopsy which will determine if it's cancer or not.  IF THE NODULE IS BIG ENOUGH FOR A BIOPSY DO NOT ALLOW THE DOCTOR TO WAIT 6 MONTHS TO "WATCH IT"!!!  INSIST ON A BIOPSY!!  My first doctor wanted to wait and watch it.  LOL  What a joke.  Keep me stressed out and put my life on hold.  Sometimes they don't reverse the situation.  I learned from this situation to always get my medical records and take charge of my own care.  There are good doctors, like Dr. Lupo, who care and then there are lazy doctors who only think about the money they are making.  I encourage you to read your own medical records, do your own research and educate yourself and also ALWAYS get a second opinion.  My nodule was first found 2 years before I was diagnosed.  I was told 98% of these are nothing to worry about and all we had to do was "watch it" every 6 months.  I eventually discounted it and forgot about it because my doctor was so unconcerned.  I wish he had taken it more seriously.  Maybe I would have had to lose my left ovary if he had.  Anyway, I wish you the best of luck and I hope you get good news and can start your family soon.  I know I felt my clock ticking.  I'm 36 now and with this being my first pregnancy I am filled with nothing but worry.  I'm 8 weeks along now and hoping I don't miscarry.  I know I'm still in that early stage where it's possible.  I'm just hoping my baby will be healthy and happy.  It's my only wish.  :-)  Good luck to you and best wishes!.
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231441_tn?1333896366
Hi,

for the vitamin D, you can buy vitamin D3 at any health food store.  It is not expensive.  

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