Thyroid Cancer Treatment Concerns

[djfromgr]

My wife has been going through Thyroid cancer treatment. I should bring up that at this point we have only dealt with the general surgeon. She had a TT for papillary cancer on July 24th. She was supposed to get the iodine scan when her TSH level reached 50. On a monday 4 weeks later her TSH level was 42.25 then on Thursday her TSH level was 41 and by the following Monday TSH was 37. They decided to proceed with the scan, but the scan showed a very high uptake (Not sure on %). The radiologist decided to take a similar treatment path as Graves disease and give an initial RAI of 20 mCi and hope that it would kill enough tissue so the TSH levels would reach 50 so they can proceed with a higher dose. The general surgeon has never had a patient that required two RAI treatments and was unaware that RAI treatments could not be administered within two to three weeks. Two weeks after the initial RAI treatment her TSH was 79. Now she is being told she has to wait 4-6 months before the next RAI treatment. She was told she could start the synthroid but would have to be off of it for a few weeks before the next RIA treatment in order to increase her TSH level.  Does this sound like it's on the up and up?? At this point is there any other treatment path that should be considered?

We are planning to get a second opinion from an endogronoligist and I came across this board and decided to post our concerns. Thanks in advance for your help.

[Mark Lupo, M.D.]

This is not the typical scenario for post surgical RAI treatment.  The 20mCi she received may have been enough to ablate the remnant depending on her case and the extent of the initial surgery.

I would look carefully at the surgical pathology report -- note the size of the tumor and if was one site or multifocal.  Also was there extension outside the thyroid?  Was it classic PTC (papillary thyroid cancer) or a more aggressive subtype?  Were there lymph nodes involved (or even looked at?)?

These issues help us decide if RAI is needed and may help in deciding the dose.

Before another dose is considered, I would also do a neck ultrasound as well as blood tests for thyroglobulin -- while the TSH is high would be a great time to check this level -- this reflects the amount of thyroid tissue (benign OR cancer) that remains.  Its use sometimes is limited by the presence of thyroglobulin antibodies -- so these must be measured each time the Tg is measured.

TSH needs to be ideally above 30 for treatment.  Another option that the FDA is likely to soon approve is the use of thyrogen injections to prepare for treatment (ie, no need to come of synthroid) -- many centers....already do it this way....

Would consider checking thyroidologists.com or thyroid.org to find a thyroid specialist to help review the situation.

[DENNIS D.]

I would stop seing that doctor and find an Endocrinologist and a surgeon that only deals with thyroids surgury,  like in a cancer center or cancer hospital in your area.

go to google search engine to find top doctors in your area..

[djfromgr]

Sorry, I forgot to mention that my wife is only 28. I thought that might be relevant.