what's next

[evita10]

First I must say I am not a native English speaker so excuse any mistakes I make.

I had a TT in Semptember 08 due to papillary cancer. 10 lymph nodes were taken out of which 5 were cancerous. RAI followed in November the same year (150mci). The WBS done one week after taking this high dose showed no distant metastasis  and  uptake only in the area where the thyroid used to be. In June 09 I had a neck ultrasound which showed a cyst and some possibly enlarged lymph nodes. A few days later I did a WBS after taking the  thyrogen injections. The WBS was clear but the Tg stimulated was 17. (non stimulated was 3,5).  I had a neck CT which was clear apart from the cyst mentioned above which was not reported as a pathological finding. My endocrinologist suggested I should take a vacation and then discuss about it again!!! So now I am at a point where the Tg unstimulated has really risen (9,3), I just had another ultrasound which showed 3 suspicious lymph nodes and I also had an FNA on the cyst and waiting for the results. I went to another endo for a second opinion and she was surprised why I wasn’t sent for another round of RAI and she is also waiting for the FNA results to see if the RAI will be the only treatment or I should have a surgery before that.  If the FNA is positive what do you think the next step should be and what if it’s negative (which I doubt). I know this is a subject that has already been discussed and answered but I am freaking out here because I have a feeling that I will go through the same hell again and the cancer will still be there.

What's thyroglobulin-needle washout? I know the analysis on the sample drawn by the FNA is performed by a cytologyst in the country I live, isn't that enough?

Thanks in advance!

[evita10]

Thank you for your answer
The FNA had no results because only blood was drawn and when the doctor tried to repeat it in a region that was more possible to take a goog sample he couldn't reach it because the suspicious area is very small (3,5mm) and behind the jugular vein, so now what?

[Mark Lupo, M.D.]

If the FNA is positive, surgery is the next step -- the key is finding a good thyroid cancer surgeon who can clean out the lymph nodes correctly.

If the FNA is "negative" then would repeat with Tg washout on the FNA sample -- this is often positive in cystic lymph nodes when the cytology is negative.

Additional I-131 could be considered after more surgery, but alone would not likely be curative for this situation.