Tenderness in Tyroid Bed after Thyrogen Injections

chiefmeat68

History: I had/have papillary thyroid cancer. It had moved into my lymph nodes but only right around the thyroid bed. I had a total thyroidectomy last July and then the RAI first part of September.

Present: I am now going in for a follow-up scan. I have been on the low iodine diet and just had my thyrogen injections the past two days and i get my RAI in about an hour. My question is that yesterday after my second thyrogen injection I started to feel some tenderness in my thyroid bed were the thyroid had been removed. I am not seeing this as a good sign. Has anybody else had this sensation? My wife thinks it is placebo effect but it is real. I was under the assumption that thyrogen wouldn't cause any tenderness even if there was remnant thyroid tissue/cancer present. Can it? I am wondering if there could be any other explanation for this tenderness other than remnant cancer?

Baldy

Tenderness
Can you be more specific? is it when you swallow? or when you physically press on the area?

When I had my Thyrogen shots, I didn't experience anything like that and I did have a remnant that showed up in the scan. According to my endo and my surgeon both, it's almost impossible to remove every bit of thyroid. They're very careful {or at least they should be} not to remove or damage your parathyroids and there are a number of fairly major vessels and nerves in that area that they have to be careful of.

The only side effect I had was a little unsteadiness {sort of a very small rush} after the first shot, nothing after the second.

Alan

nasher

all the thyrogen shots do is
all the thyrogen shots do is artificialy raise your TSH levels.

I have not heard of anyone else getting sore from them.

nasher

Baldy said:

Tenderness
Can you be more specific? is it when you swallow? or when you physically press on the area?

When I had my Thyrogen shots, I didn't experience anything like that and I did have a remnant that showed up in the scan. According to my endo and my surgeon both, it's almost impossible to remove every bit of thyroid. They're very careful {or at least they should be} not to remove or damage your parathyroids and there are a number of fairly major vessels and nerves in that area that they have to be careful of.

The only side effect I had was a little unsteadiness {sort of a very small rush} after the first shot, nothing after the second.

Alan

ok more time to look things up
Sorry for the short respponse earlier i had time to look it up

---http://www.thyrogen.com/pdfs/pi.pdf--- (i cant copy the table so if you want to see it you got to go to the page.

ADVERSE REACTIONS
Adverse reaction data were derived from post-marketing surveillance and clinical trials.
The percentages in Table 4 below represent adverse reactions experienced by 481 thyroid
cancer patients who participated in the clinical trials for Thyrogen. Most patients
received 2 intramuscular injections, 0.9 mg of thyrotropin alfa per injection, 24 hours apart.
The safety profile of patients who received Thyrogen as an adjunctive treatment for radioiodine
ablation of thyroid tissue remnants who have undergone a thyroidectomy for welldifferentiated
thyroid cancer did not differ from that of patients who received Thyrogen
for diagnostic purposes.
The most common adverse events (>5%) reported in clinical trials were nausea (11.9%)
and headache (7.3%). Events reported in ≥ 1% of patients in the combined trials are summarized
in Table 4. In some studies, an individual patient may have participated in both
the Euthyroid phase (Thyrogen) and Hypothyroid phase (withdrawal).

Post-marketing experience indicates that Thyrogen administration may cause transient
(<48 hours) influenza-like symptoms [also called flu-like symptoms (FLS)], which may
include fever (>100°F/38°C), chills/shivering, myalgia/arthralgia, fatigue/asthenia/malaise,
headache (non-focal), and chills.
Very rare manifestations of hypersensitivity to Thyrogen have been reported in clinical trials,
post-marketing settings and in a special treatment program involving patients with
advanced disease; these are urticaria, rash, pruritus, flushing and respiratory signs and
symptoms.
In clinical trials no patients have developed antibodies to thyrotropin alfa, either after single
or repeated (27 patients) use of the product.
Four patients out of 55 (7.3%) with CNS metastases who were followed in a special treatment
protocol experienced acute hemiplegia, hemiparesis or pain one to three days after
Thyrogen administration. The symptoms were attributed to local edema and/or focal hemorrhage
at the site of the cerebral or spinal cord metastases. In addition, one case each of
acute visual loss and of laryngeal edema with respiratory distress, requiring tracheotomy, with
onset of symptoms within 24 hours after Thyrogen administration, have been reported in
patients with metastases to the optic nerve and paratracheal areas, respectively. In addition,
sudden, rapid and painful enlargement of locally recurring papillary carcinoma has
been reported within 12-48 hours of Thyrogen administration. The enlargement was accompanied
by dyspnea, stridor or dysphonia. Rapid clinical improvement occurred following
glucocorticoid therapy. It is recommended that pretreatment with glucocorticoid be considered
for patients in whom local tumor expansion may compromise vital anatomic structures.
There have been reports of deaths in which events leading to death occurred within 24
hours after administration of Thyrogen. A 77 year-old non-thyroidectomized patient with a
history of heart disease and spinal metastases who received 4 Thyrogen injections over 6
days in a special treatment protocol experienced a fatal MI 24 hours after he received the
last Thyrogen injection. The event was likely related to Thyrogen-induced hyperthyroidism.
In post-marketing experience, there have been rare reports of events leading to death that
occurred within 24 hours of administration of Thyrogen in patients with multiple serious
medical problems. For patients for whom Thyrogen-induced hyperthyroidism could have
serious consequences, hospitalization for administration of Thyrogen and post-administration
observation should be considered. Such patients might include those with known
heart disease, extensive metastatic disease, or other known serious underlying illness.
Information from post-marketing surveillance, as well as from the literature, suggests that
elimination of Thyrogen is significantly slower in dialysis-dependent end stage renal disease
(ESRD) patients, resulting in prolonged elevation of TSH levels. ESRD patients who
receive Thyrogen may have markedly elevated TSH levels for several days after treatment,
which may lead to increased risk of headache and nausea.
Post-marketing data include cases of atrial arrhythmias in elderly patients with pre-existing
cardiac disease who received Thyrogen, and suggest that use of Thyrogen in this group
should be considered carefully.
--------
trust me its not as bad as it sounds but thats all the legal mumbo jumbo they are required to have for the med... trust me if you look up any drug you will find comments of death or such in it.

hope this helps.

Craig

chiefmeat68

nasher said:

ok more time to look things up
Sorry for the short respponse earlier i had time to look it up

---http://www.thyrogen.com/pdfs/pi.pdf--- (i cant copy the table so if you want to see it you got to go to the page.

ADVERSE REACTIONS
Adverse reaction data were derived from post-marketing surveillance and clinical trials.
The percentages in Table 4 below represent adverse reactions experienced by 481 thyroid
cancer patients who participated in the clinical trials for Thyrogen. Most patients
received 2 intramuscular injections, 0.9 mg of thyrotropin alfa per injection, 24 hours apart.
The safety profile of patients who received Thyrogen as an adjunctive treatment for radioiodine
ablation of thyroid tissue remnants who have undergone a thyroidectomy for welldifferentiated
thyroid cancer did not differ from that of patients who received Thyrogen
for diagnostic purposes.
The most common adverse events (>5%) reported in clinical trials were nausea (11.9%)
and headache (7.3%). Events reported in ≥ 1% of patients in the combined trials are summarized
in Table 4. In some studies, an individual patient may have participated in both
the Euthyroid phase (Thyrogen) and Hypothyroid phase (withdrawal).

Post-marketing experience indicates that Thyrogen administration may cause transient
(<48 hours) influenza-like symptoms [also called flu-like symptoms (FLS)], which may
include fever (>100°F/38°C), chills/shivering, myalgia/arthralgia, fatigue/asthenia/malaise,
headache (non-focal), and chills.
Very rare manifestations of hypersensitivity to Thyrogen have been reported in clinical trials,
post-marketing settings and in a special treatment program involving patients with
advanced disease; these are urticaria, rash, pruritus, flushing and respiratory signs and
symptoms.
In clinical trials no patients have developed antibodies to thyrotropin alfa, either after single
or repeated (27 patients) use of the product.
Four patients out of 55 (7.3%) with CNS metastases who were followed in a special treatment
protocol experienced acute hemiplegia, hemiparesis or pain one to three days after
Thyrogen administration. The symptoms were attributed to local edema and/or focal hemorrhage
at the site of the cerebral or spinal cord metastases. In addition, one case each of
acute visual loss and of laryngeal edema with respiratory distress, requiring tracheotomy, with
onset of symptoms within 24 hours after Thyrogen administration, have been reported in
patients with metastases to the optic nerve and paratracheal areas, respectively. In addition,
sudden, rapid and painful enlargement of locally recurring papillary carcinoma has
been reported within 12-48 hours of Thyrogen administration. The enlargement was accompanied
by dyspnea, stridor or dysphonia. Rapid clinical improvement occurred following
glucocorticoid therapy. It is recommended that pretreatment with glucocorticoid be considered
for patients in whom local tumor expansion may compromise vital anatomic structures.
There have been reports of deaths in which events leading to death occurred within 24
hours after administration of Thyrogen. A 77 year-old non-thyroidectomized patient with a
history of heart disease and spinal metastases who received 4 Thyrogen injections over 6
days in a special treatment protocol experienced a fatal MI 24 hours after he received the
last Thyrogen injection. The event was likely related to Thyrogen-induced hyperthyroidism.
In post-marketing experience, there have been rare reports of events leading to death that
occurred within 24 hours of administration of Thyrogen in patients with multiple serious
medical problems. For patients for whom Thyrogen-induced hyperthyroidism could have
serious consequences, hospitalization for administration of Thyrogen and post-administration
observation should be considered. Such patients might include those with known
heart disease, extensive metastatic disease, or other known serious underlying illness.
Information from post-marketing surveillance, as well as from the literature, suggests that
elimination of Thyrogen is significantly slower in dialysis-dependent end stage renal disease
(ESRD) patients, resulting in prolonged elevation of TSH levels. ESRD patients who
receive Thyrogen may have markedly elevated TSH levels for several days after treatment,
which may lead to increased risk of headache and nausea.
Post-marketing data include cases of atrial arrhythmias in elderly patients with pre-existing
cardiac disease who received Thyrogen, and suggest that use of Thyrogen in this group
should be considered carefully.
--------
trust me its not as bad as it sounds but thats all the legal mumbo jumbo they are required to have for the med... trust me if you look up any drug you will find comments of death or such in it.

hope this helps.

Craig

This may be what I am
This may be what I am experiencing....

"In addition,sudden, rapid and painful enlargement of locally recurring papillary carcinoma has been reported within 12-48 hours of Thyrogen administration. The enlargement was accompanied by dyspnea, stridor or dysphonia."

I didnt have any of the 'dyspnea, stridor or dysphonia' but did have mild pain.

Thanks nasher for the info. I get my scan tomorrow so that should answer a lot.