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No Thyroid and low TSH and HIGH Free T4

lolitabeats1
Posts: 6
Joined: Aug 2011

I had my thyroid removed two years ago, neck lymph nodes removed 5 months ago. My TSH came back .08 and Free T4 1.4. From what I read I have hyperthyroidism. What does this mean to someone who does not have a thyroid, do I still have cancer?

alapah's picture
alapah
Posts: 258
Joined: Oct 2009

TSH is thyroid stimulating hormone and Free T4 measures  how much converted Synthroid or Levothyroxine is available in your system. As a thyroid cancer patient your docs will want to suppress your TSH production because by regulating your dose of Synthroid/Levo appropriately. The idea is to give you enough external meds to prevent the remaining thyroid cells in your body from being active.

Your doc determines what TSH level is best for you and they use those labs to see how you're processing the replacement hormone. The dosage of Synthroid/Levo that you take affects these numbers. Many/most thyroid cancer patients are given daily doses of Synthroid/Levo at a level meant to suppress the production of TSH. Mine is something like .03. That sort of number is in the range of hyperthyroid. Your body converts that Synthroid/Levo into a usable form of the hormone which is what the Free T4 measures. Normal range for Free T4 is between 0.7 and 2.0 so yours is fine. 

Neither of these labs tell anything about cancer. You may be confusing Tg (thyroglobulin) with these labs. Thyroglobulin is only produced by thyroid cells and can be used to gauge whether remaining cells are active. In thyroid cancer patients Tg is mointored to note changes, or increases, in the Tg. When Tg increases in a thyroid cancer patient it may be a sign that cancer has returned. Tg in itself only indicates acrive thyroid cells - it's not a test for cancer per se. However, increases can be sign of a recurrance.

You should always ask your doctor(s) what the labs are for and what they mean - or any other questions. My doc explains all of these labs to me and why she is or is not concerned. 

Best to you

eileen

dhunt64817's picture
dhunt64817
Posts: 16
Joined: Jan 2013

I sure could use your help. I had my thyroid removed in January. They took blood for a TG test. The TG came back at 1.0 but the antithyroidgolbulin came back at 499. The Dr said that the TG could not be trusted and the lab they sent it to could not seperate the two. So they took more blood and sent it to a different lab.

 

dhunt64817's picture
dhunt64817
Posts: 16
Joined: Jan 2013

I sure could use your help. I had my thyroid removed in January. They took blood for a TG test. The TG came back at 1.0 but the antithyroidgolbulin came back at 499. The Dr said that the TG could not be trusted and the lab they sent it to could not seperate the two. So they took more blood and sent it to a different lab.

 

lolitabeats1
Posts: 6
Joined: Aug 2011

What an awesome response! Thank you I feel much better. I am currently waiting for a call from my doctor but in the meantime I feel so my better. God bless you.

dhunt64817's picture
dhunt64817
Posts: 16
Joined: Jan 2013

I had my first  blood test for TG level after having my thyroid removed in January. The TG level was 1.0 ng/mL. However the Dr said it was not to trusted because the Antithyroidgolbulin came back at 499. The lab they sent it to could not seperate the two? Does this sound correct?

So they are sending new blood work to another lab. I thought the TG blood test was a simple test and that you would need a thyroid to produce antithyroidblobulin.

 

alapah's picture
alapah
Posts: 258
Joined: Oct 2009

I'll try to write this one without all they typos/missed wording I made in that last one!

Tg anitbodies are indeed a problem. I have them - TgAB is what i have. The TgAB does make it hard or nearly impossible to derive a Tg reading that is meaningful or accurate. What those labs are effectively indicating is that thyroid cells remain - those remaining cells are producing Tg and the TgAB. A surgeon cannot remove every thyroid cell in your body. This is why RAI is often prescribed for thyroid cancer patients - RAI targerts thyroid cells and, hopefully, kills them.

Even for patients without anibodies I have been told that it's important to have the Tg lab done at the same place each time because assays vary from lab to lab, making it hard to truy compare readings.

From what I understand there are a few labs in the country that are maybe what one might consider on the cutting edge with Tg lab accuracies though the antibodies are a problem no matter whose assay is involved. Since my first Tg (days prior to surgery) my endo has sent my bloodwork for Tg and TgAB to an endocrine lab at the University of Southern California which apparently banks your samples (freezes them) and then when they get a new one, they rerun your last one at the same time they run your new one and then compare the two. This is good because they are basically applying the same assay and conditions to both the old and new sample.

I have thyroid metasteses in my lungs which are monitored by CT because my Tg reading can't tell much. My endo hopes that the degree of rise in Tg is some indication of the degree of cancer activity but my medical oncologist doesn't necessarily think there is a correlation. No matter what your situation, though, the key is to monitor trends so if your Tg and/or TgAB is rising, that could be a sign of recurrance. 

Hope that helps. I am not a doc but this is my understanding from several years working with them and talking about my treatment.

Did you have a Tg lab run before your surgery? Did you have RAI? I see you've only recently had surgery - and if you had RAI it's still working away (it works for six months). Also, my endo said that she's seen TgAB rise after RAI and then slowly decrease over that 6 month time period so in your case, you may just want to file away the info for later because your body might be working through the process of killing those thyroid cells etc.

Best to you!

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