Cancer is a Systemic Disease

--- On Thu, 4/30/09, lpomije From: lpomije Subject: [thyroidcancerhelp] Ultrasound negative, WBS positive and Tg
22--what next?
To: thyroidcancerhelp@yahoogroups.com
Date: Thursday, April 30, 2009, 3:06 PM
Dear Dr. Ain,
My stats:-Nov. 2007 neck ultrasound reveals 3 nodules with
calcifications -Jan. 2008 FNA inconclusive but suspicious for follicular
neoplasm -Near-total thyroidectomy Feb. 2008 due to intraoperative
papillary thyca diagnosis -5/5 lymph nodes removed positive for
papillary thyca -150 mCi RAI March 2008 -April 2009 with a TSH of 60.27,
Tg is 22, no Tg antibodies -I-123 full-hypo and LID prep WBS April 2009
shows linear area of uptake in right surgical thyroid bed, measuring
about 2 cm long -FNA was scheduled for this morning but was cancelled
after pre-FNA ultrasound failed to show any thyroid tissue or enlarged
nodes or anything suspicious whatsoever to biopsy. What now? Chest CT?
PET scan? Empiric RAI tx? Surgery?
I've read all the ATA guidelines and NCCN guidelines and would like to
know what your approach to a situation like this would be.
Thank you, Dr. Ain. With great respect, Lynn in California

Subject: Persistent thyroglobulin equals persistent tumor


Dear TCH Members,

Sometimes physicians have "tunnel vision". They forget that thyroid cancer is a
systemic disease (involving the entire body). They focus on the neck and avoid
evaluating the remainder of the body for metastatic tumor. Elevated
thyroglobulin levels mean that a thyroid cancer patient (after previous
thyroidectomy and radioiodine therapy) has persistent or metastatic disease.
Such tumor is either microscopic (in deposits too small to be detected by
diagnostic studies) or sufficiently macroscopic to be able to be detected. This
can only be determined by a conscientious and comprehensive effort to search for
tumor (PET scans, CT scans, ultrasounds, etc.). Sometimes, if iodine-non-avid
disease has not been established as present, an empiric radioiodine therapy
(with excellent hypothyroid and low iodine diet preparation) is warranted to see
if the post-therapy whole body scan is positive and the thyroglobulin diminishes
in response. If such an approach
proves unfruitful, then it is important to pursue evidence for macroscopic
tumor.

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THE INFORMATION CONTAINED IN THIS COMMUNICATION IS INTENDED
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************************************************
Kenneth B. Ain, M.D.
Professor of Medicine & The Carmen L. Buck Chair of Oncology Research
Director, Thyroid Oncology Program
Division of Endocrinology & Molecular Medicine
Department of Internal Medicine, Room MN524
University of Kentucky Medical Center, 800 Rose Street, Lexington, KY
40536-0298
& Director, Thyroid Cancer Research Lab., Veterans Affairs Med. Cntr, Lexington,
KY