Had TT 2007 Dx Hashimoto disease. Hurthle cell adenoma with follicular changes >4cms.Multinodule goitre. No RAI given after TT. T4 dosing hyper on low doses and hypo on higher doses, with severe FT4 and TSH decreases after several months.Raise dose by 3mcg same pattern occurs. 150mcg thyroxine now. TgAB increased to 99 recently from 83 1 yr ago, 63 previous year. Ref < 60 U/ml. TPO ab's now 160 dropped from 180 in 2011, and in 2010 190. Ref <60 U/ml Serum ferritn raised from normally 40 for many years to 287 in March 2012. No ref range. 'Low normal' iron studies. Potassium slightly decreased, kidney function testing showing some lowering function. L kidney 9.2 cms R kidney 11.5 cms with increase since 2010 (both normal at around 9cms at that time) Q; does the rising of TgAb and sudden sreum ferritin indicate a recurrence of any thyroid cancer? U/S shows no tissue in thyroid bed. Doc did not do Thyrogen nor thyroxine withdrawal when checking thyroglobulin, which resulted in undetectable Tg. I am aware TgAB's interfere with that test. Doc did not explain why not done the Tg test without Thyrogen but rather, said TgAB and TPO will 'always be there' However I am aware TPO can take up to 6+ years to dissipate and less for TgAB, however mine have increased slightly. Would you suggest further investigations? Thank you.
From what you wrote, I do not know exactly the thyroid cancer history if there was one. The thyroglobulin antibody may take 3 years on average to normalize after eradicating all thyroid tissue. Thyrogen stimulated thyroglobulin panel is in patients with positive antibodies are hard to interpret. A whole body scan could be interpreted but without having received radioactive iodine, we typically do not do I-131 whole body scan. Thyroglobulin antibody level should not consistently elevate with this history however and a simple test would be neck ultrasound to evaluate for remaining thyroid tissue or abnormal lymph nodes. The thyroglobulin antibody level may fluctuate based on the amount of TSH suppression. You should review this with your endocrinologist to see if the trend is concerning or not.
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