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TSH increase
Hi,

My TT was in 07/2011 for a 1cm nodule with undeterminate lymph nodes metastasis (psamomma bodies in one LN but no metastatic disease, four other LN neg), highly unlikely extrathyroidal extension, clear margins.  There were two 2 mm foci in both lobes also.  My cancer was conventional papillary.  I am 42 yo male.  My post TT ultrasound five months ago showed no sign of residual disease and at that point my was Tg undetectable.  I was put on 137mcg Synthroid and was advised no RAI but careful management and observation.

My TSH after I started on Synthroid was very low and it gradually increased to 0.10 in 11/2011.  My latest blood work on 02/2012 indicated that my TSH has increased to 1.3.  This is higher than the 0.1-0.5.  My Synthroid dose has been increased to 150mcg to bring it to that suppressed range.

My question is that I am concerned that my high TSH will cause thyroid tissue to grow and increase the chance of recurrence.  I am concerned that because I did not have RAI, I have remnant thyroid tissue and because I had multifocal disease, my risk of recurrence would increase because of this high TSH.  I feel fine and not hypothyroid.  I would really appreciate your input on this.  Am I worrying unnecessarily?

Thank you!
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Yes, there is a chance that higher TSH will cause recurrance. It is nearly impossible to remove ALL the thyoid tissue, that is why they do RAI for tumors over 1.5 cm, and sometimes they do it with smaller tumors with multiple foci. I think it is optional for 1 cm tumors, did they give you an option to have it? You must keep your TSH .1 or lower to prevent recurrance, even though you feel fine. If your thyroglobulin starts rising they may eventually do RAI.
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