Dr. Ain Weighs In

--- On Tue, 5/26/09, lpomije Dear Dr. Ain,
After a second (empiric) dose of 150 mCi RAI to treat stimulated Tg of
22 (no TgAb) and WBS showing uptake in the neck but negative u/s and
negative MRI, when should the following be done:

-u/s
-suppressed Tg/TgAb
-stimulated Tg/TgAb
-WBS (not the post-treatment WBS, but well after that)

Thank you for your time. Sincerely, Lynn in Orange County, California
.......
4/13/09 TSH 60.27; Tg 22
4/16/09 WBS: "linear" uptake in neck
......

Dear TCH Members,

Often, "linear" uptake in the neck is not coming from thyroid cancer, but rather
from radioactive saliva that is coating the esophagus. I have my patients peel
and eat a large lemon (as if it is an orange) one hour before their scan, then
swish & swallow a mouthful of water every 10 minutes until the scan is started.
This has been effective in reducing the error of mistaking salivary
contamination from actual tumor.

Anytime that an empiric treatment of radioiodine is administered for elevated
thyroglobulin (using a hypothyroid preparation and a low iodine diet), it should
be followed (within 2 to 7 days) by a "post-therapy" whole body scan. If the
scan demonstrates uptake of the radioiodine in a tumor site, then it suggests
possibly effective treatment, if no uptake, it still might have been of benefit.
I restudy the patient with a stimulated thyroglobulin (hypothyroid or Thyrogen)
6 months later. If the thyroglobulin is NOT significantly reduced (accounting
for Thyrogen increasing the thyroglobulin to only one third of the level seen
with hypothyroidism), then it signals that the residual thyroid cancer is no
longer responsive to radioactive iodine.

**************PLEASE BE ADVISED*********************
THE INFORMATION CONTAINED IN THIS COMMUNICATION IS INTENDED
FOR EDUCATIONAL PURPOSES ONLY. IT IS NOT INTENDED, NOR SHOULD
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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