Follicular Variant Papillary Carcinoma

[eaverett]

Hello All!

I have been following these posts very closely over the last few months trying to get information on thyroid cancer.  I am impressed with the knowledge and the willingness of the medical professionals to share their time in responding to the many questions.  With that said, I am now compelled to ask my own question-

I am a 38 year old male and was recently diagnosed, after completion thyroidectomy (CT) on 4-18-08 with follicular variant papillary carcinoma (FVPC).  The path. report stated the tumor size was 1.2cm with no  "extrathyrodial extension or lymphovascular invasion identified" "appears completely excised".  There were two microcarcinomas (.1 and .2 cm) found in the lobe of the thyroid - both papillary.  Things seemed to be ok (based upon pathology etc.) Surgeon indicated he felt it was not cancer and left the isthmus in post op report.  Left lobe had been removed 7 months prior for a nodule but the nodule was a follicular adenoma (benign).   Because path. on this lobe came back as FVPC  the surgeon recommended referral to endocrinologist for radio active iodine ablation and follow-up.  Met with endo and received ablative does of 100 (mcui?) of radio active iodine with a whole body scan (WBS) at day 7.  WBS came back with "abnormal tracer activity noted in bilateral lungs" with a recommendation for CT to check for metastasis in lungs.

My lab work is as follows:
CT done on 4-18-08
1.   5-9-08 Thyroglobulin  = 1.2 ng/ML (prior to TSH stimulation)  TSH= 29.6 mcIU/ML
2.   5-27-08 Thyroglobulin = 2.6 ng/ML TSH at 65 MIU/ML while on low iodine diet
3.   5-30-08 Radioactive Iodine Ablation (100 mcui?)
3.   6-12-08 Thyroglobulin = 5.1 ng/ML - TSH still elevated at 45 MIU/ML while on .15mcg of synthroid.

Questions-
1.  Is it usual/possible to have lung metastasis with a tumor that the pathology report showed no extrathyroidal extension or lymphovascular invasion?  
2.  Does the lab results showing increasing thyroglobulin mean anything.  I am concerned about the results in the 3rd series having 5.1ng/ML but not sure if it means anything because it is so close to ablative dose (only 12 days post ablative dose).  I have been unable to contact my endo (she is out of town for two weeks) and this is weighing on my pretty heavy.  I am also concerned that my TSH has not dropped while on the synthroid for the last 8 days.  I am still pretty hypo with a 45 TSH and still feel many of the symptoms.  Is it normal to take so long to get the TSH down?

I appreciate the time everyone puts into these forums and any comment/ response would be very helpful.

Thanks,

Eric

[JoanFowler]

Sounds like you're having quite a time there. I'm thinking you might consider also posting this to Ask the Doctor (Dr. Lupo's) forum too. He's given me and others great answers.

In the meantime, as a practical suggestion, I wonder if your endo has a backup person, or if you could see or call the surgeon or your regular doc to get the CT Scan ordered and possibly answer some of your questions while you're waiting.  That way, the endo will have the results when she gets back in town.

Since most of your questions are medically oriented, I'll just tell you my experience.

Had total Thyroidectomy 8/30/07 to deal with 3 nodules. Two were pap carcinoma about 1 cm, the other just a cyst of some sort.Started with 100 mcg of Synthroid, got moved up to 112, and then to 125 which seems to be the right level.  This was over the course of 7.5 months.  While I was able to function during the adjustment period, I was definitely affected by it. Didn't realize how lousy I was doing until the level was right.

In my case, there was some extrathyroidal growth, but the lymph nodes didn't seem to be invovled. I had 100 millicures of radioactive iodine in October and a scan 14 days later I think that appeared clear.  Now one of my lymph nodes has some abnormalities, so I am going for more evaluation. I don't know what my thyroglobulin level is becasuse the doctor didn't have it when he initially told me about the US results, and then when I called him back a few days later, he was out of town for a week!  Today, supposedly the office person is going to call me with the Thyroglobulin level.

Please keep us up to date.

[ChitChatNine]

Hello Eric,

WELCOME TO THE THYROID COMMUNITY!  This is a great place to give, get, gain and share information and advice and maybe in the process you may make a friend or two along the way!  This community here is patient to patient ... not medical professional but we have lots of experience to share!

I, too, had follicular adenomas along with 2 papillary microcarinomas.  

I am so glad you had the testing done and will follow thru with the possible lung involvement.  I wish I had an answer for you.  If not many answer maybe repost (and tell them at my suggestion you are reposting) and ask in  short paragraph if the lung can have metastatic involvement as you described in your post.  You may get an answer with one ? and then can refer them back to this post maybe by cutting the link and pasting it.

I wanted to stop by and [ wave ] hello and again, WELCOME to our COMMUNITY!

Cheryl - co-community leader thyroid