Return of Thyroid Cancer???

cchqnetman

My wife had thyroid cancer 5 years ago. The entire thyoid was removed. Her TSH has always been around 1. It was just checked and it was 4. Could this indicate her thyrod cancer is back? What would the other signs of the return be???

We are battling rpostate cancer with me and now this popped up.

Thanks for any advice!!!!

David

alapah

Hello David,
Sorry to hear that both you and your wife have been facing cancer diagnoses. I think you may be mixing up two different tests/measures but it's important to know for certain. TSH is thyroid stimulating hormone - the hormone we all need and that must be replaced in persons who no longer have a thyroid. Your wife must take levothyroxine (Synthroid) as a replacement. A normal TSH would be somewhere between 1 and 3 I believe. In thyroid cancer patients it is kept on the low end - often below zero. If it is higher, levothyroxine levels should be adjusted accordingly to keep the patient hyperthyroid.

That said I do wonder if you really mean Tg rather than TSH. Tg stands for thyroglobulin which is produced only by thyroid cells. After full thyroidectomy and radioactive iodine treatment (if that route is taken) the goal for thyroid cancer patients is to have a Tg of zero as this is an indication that no thyroid cells remain in the body. When Tg is present and/or rises, it usually means some residual tissue or free floating cells remain. I think it's not uncommon to have this happen and often patients will receive an additional round of RAI to try to kill those remaining cells. Positive Tg levels only indicate that thyroid cells exist - it does not indicate whether those cells are cancerous. Only a PET or RAI scan can reveal if those cells are cancerous.

It is very important to have Tg levels tested by the same lab every time because assays vary from lab to lab. Another thing to be aware of is Tg antibodies, as antibodies can mask or mess with the Tg measure. A fair number of patients have antibodies but not all of course.

I hope that she is under the care of an endocrinologist who really knows thyroid cancer - not all do so if you can shop around and find someone up on it I would say go for it. Quality, well informed follow up care is critical. Labs, ultrasounds and sometimes other scans are all part of the ongoing care process - or at least they should be. I'm not sure of statistics but it seems that reoccurance often takes the form of cancer cells within lymph nodes in the neck or within the thyroid bed.

If you're not already familiar with it, there is a site full of useful information (including explanations of thyroid labs) called thyca.org (the thyroid cancer survivor's group).
Very best to you both.
eileen

cchqnetman

alapah said:

Hello David,
Sorry to hear that both you and your wife have been facing cancer diagnoses. I think you may be mixing up two different tests/measures but it's important to know for certain. TSH is thyroid stimulating hormone - the hormone we all need and that must be replaced in persons who no longer have a thyroid. Your wife must take levothyroxine (Synthroid) as a replacement. A normal TSH would be somewhere between 1 and 3 I believe. In thyroid cancer patients it is kept on the low end - often below zero. If it is higher, levothyroxine levels should be adjusted accordingly to keep the patient hyperthyroid.

That said I do wonder if you really mean Tg rather than TSH. Tg stands for thyroglobulin which is produced only by thyroid cells. After full thyroidectomy and radioactive iodine treatment (if that route is taken) the goal for thyroid cancer patients is to have a Tg of zero as this is an indication that no thyroid cells remain in the body. When Tg is present and/or rises, it usually means some residual tissue or free floating cells remain. I think it's not uncommon to have this happen and often patients will receive an additional round of RAI to try to kill those remaining cells. Positive Tg levels only indicate that thyroid cells exist - it does not indicate whether those cells are cancerous. Only a PET or RAI scan can reveal if those cells are cancerous.

It is very important to have Tg levels tested by the same lab every time because assays vary from lab to lab. Another thing to be aware of is Tg antibodies, as antibodies can mask or mess with the Tg measure. A fair number of patients have antibodies but not all of course.

I hope that she is under the care of an endocrinologist who really knows thyroid cancer - not all do so if you can shop around and find someone up on it I would say go for it. Quality, well informed follow up care is critical. Labs, ultrasounds and sometimes other scans are all part of the ongoing care process - or at least they should be. I'm not sure of statistics but it seems that reoccurance often takes the form of cancer cells within lymph nodes in the neck or within the thyroid bed.

If you're not already familiar with it, there is a site full of useful information (including explanations of thyroid labs) called thyca.org (the thyroid cancer survivor's group).
Very best to you both.
eileen

Thanks
Eileen,
Thanks so much for you quick response. It is TSH she had measured. She explained it to me that it is supposed to be below 2 for a person with a thyroid. They try to keep hers around 1. She does take Synthroid. She is supposed to go back to her primary care doctor on Wednesday. She is going to have the test repeated and then if it is still high she will go back to her endocrinologist.

Thanks again!!!!


David