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Best Solution for my Brother Issue
First Follow Up report TT and RAI on 29-10-2010 here what I got thyroid fresh Profile result and ultrasound after 20 days LID and without taking thyroxin pills. Serum T3= .40 nmol/L while normal Range is (1.26-3.28) Serum T4 =1.28 ug/dl (6.4-13.3) Serum TSH > 100 ulU/ml. Serum FT4= .18 ng/dl while normal Range (.93-1.7), Serum Thyroglobin (Tg) =9.9 ng/ml while Normal range (below 55). Measuring Units may be different from the Pakistani hospitals in your own country. All above blood test were done through AKU-hospital with their defined measuring unites. Only issue left with my case is ultrasound shows and Whole body scan shows Nodes of Measuring .8 cm =( 8 Mille Meter) in one and small two other nodes in Right side of Neck. While in October 2010's W.B.S scan there was good uptake of the R.A.I on all Thyroid Tissue on right and Left side of Neck
(An exact word of ultra sound is " Impression: Status post thyroidectomy. No evidence of recurrence of disease in the region of thyroid bed. Chain of right Side enlarged cervical lymph nodes noted, the largest one measuring approx. . . 8 cm in short axis, no definite collection identified) while exact words or NM I-131 W.B.S conclusion. Whole Body I-131 (diagnostic scan) revealed evidence of residual (Left over) disease over thyroid bed & cervical nodes (predominantly (Largely) on the right side).Which report finding we can trust on this point of time?
Dear friend our doctor Dr Najum Islam (Pediatric Endocrinologists at Aga Khan Hospital ) and Dr Masi Zaman (Radiation Oncologist at AKU) all have called Panel to find way out for this 8mm Node and report finding of NM I-131 W.B.S & ultrasound as on June 13, 2011. I request all of you if you can give your opinion or can discuss with your doctors regarding the case so that we can get better and secure way out for my brother of aged 15. which ever is best for his health and life we want to use that route. what about ethyl alcohol injections for thyroid in this case.
(An exact word of ultra sound is " Impression: Status post thyroidectomy. No evidence of recurrence of disease in the region of thyroid bed. Chain of right Side enlarged cervical lymph nodes noted, the largest one measuring approx. . . 8 cm in short axis, no definite collection identified) while exact words or NM I-131 W.B.S conclusion. Whole Body I-131 (diagnostic scan) revealed evidence of residual (Left over) disease over thyroid bed & cervical nodes (predominantly (Largely) on the right side).Which report finding we can trust on this point of time?
Dear friend our doctor Dr Najum Islam (Pediatric Endocrinologists at Aga Khan Hospital ) and Dr Masi Zaman (Radiation Oncologist at AKU) all have called Panel to find way out for this 8mm Node and report finding of NM I-131 W.B.S & ultrasound as on June 13, 2011. I request all of you if you can give your opinion or can discuss with your doctors regarding the case so that we can get better and secure way out for my brother of aged 15. which ever is best for his health and life we want to use that route. what about ethyl alcohol injections for thyroid in this case.
MEDICAL PROFESSIONAL
This is a complicated case.
Ethyl alcohol is usually reserved for non-surgical candidates.
The Tg of 9.9 with TSH>100 along with US and WBS findings suggest persistent disease in the neck but not likely metastasis outside the neck.
Options:
1) close observation to determine trend in US findings and TG levels. If trending upward then need to move forward with treatment.
2) Additional neck surgery - usually preferred over I-131 for identifiable nodes -- but the node(s) would need FNA biopsy first to confirm these are papillary thyroid cancer.
3) More I-131.....not usually our first choice a this time, especially at his age.
Would recommend taking into account the biologic behavior of the cancer (the pathology from the Dec 2010 surgery). If classic papillary cancer, then observation may be best at this time.
Ethyl alcohol is usually reserved for non-surgical candidates.
The Tg of 9.9 with TSH>100 along with US and WBS findings suggest persistent disease in the neck but not likely metastasis outside the neck.
Options:
1) close observation to determine trend in US findings and TG levels. If trending upward then need to move forward with treatment.
2) Additional neck surgery - usually preferred over I-131 for identifiable nodes -- but the node(s) would need FNA biopsy first to confirm these are papillary thyroid cancer.
3) More I-131.....not usually our first choice a this time, especially at his age.
Would recommend taking into account the biologic behavior of the cancer (the pathology from the Dec 2010 surgery). If classic papillary cancer, then observation may be best at this time.
MEDICAL PROFESSIONAL
Treatment options are 1) surgery or 2) more radioactive iodine.
More surgery is usually preferred if there is a clear target.
The 8mm node is not proven yet to be cancer.
Bilateral neck dissection means cutting out a large number of lymph nodes in the lateral neck (sides of neck) on both sides. This should also include repeat clean out (dissection) of the central neck (area around the windpipe). It is a big surgery with risks of damaging nerve going to voice-box as well as the parathyroid glands (which control calcium) and the the nerve that helps the shoulder move.
If the only identifiable node is 8mm and the Thyroglobulin off thyroxine last week was 9.9, then many experts would monitor (observe). Additional testing at this time could include CT scan of the neck to make certain there is not a large mass or node the ultrasound missed. We would usually biopsy the node to confirm it's cancer and then re-consider options for surgery. Usually we don't do bilateral neck dissection unless there is disease on both sides.
Radical neck dissection is not indicated - it means removing blood vessels and muscles in the neck and is too drastic for most thyroid cancer cases.
More surgery is usually preferred if there is a clear target.
The 8mm node is not proven yet to be cancer.
Bilateral neck dissection means cutting out a large number of lymph nodes in the lateral neck (sides of neck) on both sides. This should also include repeat clean out (dissection) of the central neck (area around the windpipe). It is a big surgery with risks of damaging nerve going to voice-box as well as the parathyroid glands (which control calcium) and the the nerve that helps the shoulder move.
If the only identifiable node is 8mm and the Thyroglobulin off thyroxine last week was 9.9, then many experts would monitor (observe). Additional testing at this time could include CT scan of the neck to make certain there is not a large mass or node the ultrasound missed. We would usually biopsy the node to confirm it's cancer and then re-consider options for surgery. Usually we don't do bilateral neck dissection unless there is disease on both sides.
Radical neck dissection is not indicated - it means removing blood vessels and muscles in the neck and is too drastic for most thyroid cancer cases.
My brother case has been discussed in multi Team Meeting and Recommended for bilateral Neck Disection,
What do you think at this point of Time is this good decision where no FNA of 8 MM node has been taken, but AKU prefer to move on for another surgery. and What does this Bilateral Neck Dissection mean, and its difference with Radical Neck Diessection.
What do you think at this point of Time is this good decision where no FNA of 8 MM node has been taken, but AKU prefer to move on for another surgery. and What does this Bilateral Neck Dissection mean, and its difference with Radical Neck Diessection.
Can you please elaborate treatment option for my brother if trend goes up in future.
Third Blood Test was done on 24-04-2011
Case History
After diagnosis of Papillary thyroid on 01-10-2010 (First Stage T4.N1.M0 after Post operation Pathological Report) on 19-10-2010 after TT on (12-10-2010) and RAI of 150 Mci, ultrasound report seems their was no node in Right side of neck. But after 6 month Follow nodes has been developed on the right side of neck. TT with Deep neck Dissection was done, while RAI expert was satisfied with the ...RAI dose and uptake level. Mean while on 03-04-2011 Thyroid profile test TSH result was .002 lowest , T3. T4 was normal. Can any body help me to understand this that after 6 month First interval visit what does this nodes in right side of neck means, while after TT and Neck Dissection ultrasound report showed nothing !. If nodes are there how we can say it is harmful or not. Whatever is this just needed to clear the point to understand mechanics of this development.
Thyroid Profile Results: First Blood Test on 09-12/2010
Serum T3 = Not Done nmol/L While Normal Range (1.26 - 3.28)
Serum T4 =Not Done ug/dl While Normal Range (6.4 -13.3)
Serum TSH = 55.03 ulU/ml (for age 21 to 54 years age Normal Range (.4-4.2)
Serum Thyroglobuline (Tg) =136.00 ng/ml While Normal Range is below 55 ng/ml
Anti Thyroglobuline =30.20 IU/ml While Normal Range is below 34 IU/ml
Anti Thyroid Peroxidase =4.10 IU/ml While Normal Range is below 12 IU/ml
Serum Calcium = 9.4 mg/dl (8.4-10.2) mg/dl
Second Blood Test on 23-02-2011
Serum T3 =1.64 nmol/L While Normal Range (1.26 - 3.28)
Serum T4 =8.12 ug/dl While Normal Range (6.4 -13.3)
Serum TSH = 17.30 ulU/ml (for age 21 to 54 years age Normal Range (.4-4.2)
Third Blood Test on 23-02-2011
Serum T3 =Not Done nmol/L While Normal Range (1.26 - 3.28)
Serum T4 =Not Done ug/dl While Normal Range (6.4 -13.3)
Serum TSH = .002 ulU/ml (for age 21 to 54 years age Normal Range (.4-4.2)
Fourth Blood Test on 09-06-2011
Serum T3 =.40 nmol/L While Normal Range (1.26 - 3.28)
Serum T4 =1.28 Done ug/dl While Normal Range (6.4 -13.3)
Serum FT4= .18 ng/dl While Normal Range (.93 -1.7) ng/dl
Serum TSH = > 100 ulU/ml (for age 21 to 54 years age Normal Range (.4-4.2)
Serum Thyroglobuline (Tg) =9.94 ng/mL While Normal Range is below 55 ng/mL
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