Re: raised TSH

[Guest guest]

Hello

- I am sorry to hear about your papillary cancer and hope the following

helps (from our web site www.tpaq-uk.org.uk

)

Our

Medical Advisor Dr Barry Durrant-Peatfield wrote that thyroid

cancer can occur in all age groups. People who have had radiation therapy to

the neck are at higher risk. This therapy was commonly used in the 1950s to

treat enlarged thymus glands, adenoids and tonsils, and skin disorders. People

who received radiation therapy as children have a higher incidence of thyroid

cancer.

Most

distressing can be marked enlargement of the thyroid, which may be symmetrical

or asymmetrical. This, the goitre may be due to a number of factors. Iodine

deficiency will cause chronic enlargement; but this is rarely seen today,

except in remote inland areas. Many people develop a diffuse, usually soft

enlargement, especially teenage girls, with no real symptoms requiring

attention. Sometimes, these quietly disappear, but they may progress to become

rather harder and with lumps and nodules over the years. It is then called

multi-nodular goitre, and may be inconvenient or unsightly. At this point,

medical advice should be sought. X-rays and ultrasound may show its full

extent, and whether further tests or intervention are required. Once such is

the use of radioactive iodine, which is taken up to a greater degree by the

abnormally active thyroid nodules and will show up as hot spots on a thyroid

scan, providing a picture of the thyroid tissue health.

It is

more common for the thyroid to present a nodule as a lump one side or the

other. Many of these patients will have had the full thyroid function tests,

but most often will have the nodule drained by a fine needle (fine needed

aspiration (FNA) for the technically minded). The fluid and cells are subjected

to microscopy. At this point, cancer cells may be looked for, which is why a

growing nodule is not something you should try to deal with yourself.

Fortunately, cancer is really quite rare and has a very high survival rate (95%

overall); the average practice may not see more than one case every few years

or so.

For the

sake of completeness, he briefly to lists the types of thyroid cancer that

occur. Early on in life, and in young women, the cancer is likely to be

papillary cancer (from its frond like appearance under the microscope). Later

on in life, after about the age of 30, the cancer is more likely to be

follicular cancer. Much rarer are medullary, lymphoma, or anaplastic cancer,

the last two really only occurring in older age groups.

Most

commonly, thyroid cancers in the early stage produce no symptoms. As the cancer

grows, a small lump or nodule can be felt in the neck. The vast majority of

thyroid nodules are caused by benign conditions, but about one per cent of

these lumps represent early stages of thyroid cancer. If the cancer spreads, it

can cause symptoms that include:

·

A lump—sometimes growing rapidly—in the front of

your neck, just below your Adam's apple Hoarseness or difficulty swallowing

·

Trouble breathing

·

Swollen lymph nodes, especially in your neck

·

Pain in your throat or neck, sometimes spreading up to your ears

·

Cough–or cough with bleeding

Having

one or more of these symptoms doesn't necessarily mean you have thyroid cancer.

Other conditions—including a benign thyroid nodule, an infection or

inflammation of the thyroid gland, and a benign enlargement of the thyroid

(goitre)—can cause similar problems, all of which are highly treatable.

Treatment

is essentially surgical; the whole gland is removed, together with any

associated glands with papillary cancer; some tissue may safely be left in

surgical treatment of the follicular form. Any stray cancer cells are mopped up

by a course of radioactive iodine a few weeks after the surgery and before

thyroid replacement has been started. It is considered good practice to prevent

thyroid stimulating, as by the TSH, to prevent occurrence; so thyroid

replacement ensures the TSH is kept very low.

·

A physical examination can reveal a thyroid mass or nodule

(usually in the lower part of the front of the neck), or enlarged lymph nodes

in the neck.

·

Tests that indicate thyroid cancer:

·

Thyroid Biopsy showing anaplastic, follicular, medullary or

papillary cancer cells

·

Ultrasound of the thyroid showing a nodule

·

Thyroid Scan showing cold nodule (a nodule that does not light

up on scan)

·

Laryngoscopy showing paralysed vocal cords

·

Elevated serum calcitonin (for medullary cancer) or serum

thyroglobulin (for papillary or follicular cancer)

·

This disease may also alter the results of the following tests:

TSH, T4 and T3.

People

with thyroid cancer often want to take an active part in making decisions about

their medical care. They want to learn all they can about their disease and

their treatment choices. However, the shock and stress that people may feel

after a diagnosis of cancer can make it hard for them to think of everything

they want to ask the doctor. It often helps to make a list of questions before

an appointment. To help remember what the doctor says, patients may take notes

or ask whether they may use a tape recorder. Some also want to have a family

member or friend with them when they talk to the doctor—to take part in

the discussion, to take notes, or just to listen.

The

doctor may refer patients to a specialist (oncologists) who specialize in

treating cancer, or patients may ask for a referral. Specialists who treat

thyroid cancer include surgeons, endocrinologists, medical oncologists, and

radiation oncologists. Treatment generally begins within a few weeks after the

diagnosis. There will be time for patients to talk with the doctor about

treatment choices, get a second opinion, and learn more about thyroid cancer.

The

following are some questions you may want to ask your doctor before treatment

begins:

·

What type of thyroid cancer do I have?

·

Has the cancer spread? What is the stage of the disease?

·

Do I need any more tests to check for spread of the disease?

·

What are my treatment choices? Which do you recommend for me?

Why?

·

What are the benefits of each kind of treatment?

·

What are the risks and possible side effects of each treatment?

·

How will the treatment affect my normal activities?

·

Would a clinical trial (research study) be appropriate for me?

Can you help me find one?

Luv -

Sheila

From my recent bloodtests, my TSH

was high and the GP now wants to talk to me about it. For information, I

have papillary cancer and shared my blood results recently with you. The

levels were 9.3 mU/L. What should he be doing? can anyone help me

understand further? I currently don't take any thyroid medication

although have started on nutri-thyroid and hope that's not going to do any harm.

Thanks again

[Guest guest]

Hi - it might help you also to read the information in this

'Patient's Guide to Thyroid Cancer and Hypothyroidism

http://www.endocrineweb.com/guides/thyroid-cancer-hypothyroidism/thyroid-cancers-connection-hypothyroidism

Also, you need to see your GP as a matter of urgency in order to

get that high TSH suppressed as quickly as possible. If you have not done so,

make an urgent appointment. Let us know how things go and good luck!

Luv - Sheila

Hi all

From my recent bloodtests, my TSH was high and the GP now

wants to talk to me about it. For information, I have papillary cancer

and shared my blood results recently with you. The levels were 9.3

mU/L. What should he be doing? can anyone help me understand further?

I currently don't take any thyroid medication although have started on

nutri-thyroid and hope that's not going to do any harm.

Thanks again

[Guest guest]

Hi again - I just want to clarify with you that papillary cancer has been diagnosed and I am currently going through strenghtening my body using iodine, supplements and dietary changes prior to considering the thyroidectomy. So I need to understand how significant the raised level of TSH is in my current condition and what I could/should be doing?

Thanks again

[Guest guest]

Hello you didn't give details of your diagnosis or your TFT's or Tg or whether you had a goitre etc. It would be an advantage in searching for info. Sheila has already posted excellent comprehensive info earlier. I've posted you a few links below that may or may not help.

On a personal note I would have my TSH lowered to undetectable ASAP.

The association between serum TSH concentration and Thyroid Cancer Kristien Boelaert

http://erc.endocrinology-journals.org/cgi/content/abstract/16/4/1065 The two links below are interactive case studies which can help understand the whole process of Thyroid Cancer from a different view ....the Doctor's Undetectable TSH is important First link "Dr Tuttle" on the "Management of Recurrent Thyroid Cancer" http://www.thyroidtoday.com/CaseChallenges/ThyroidCancer1.asp Second link "E. Chester Ridgway, MD" "Long-Term Management of Thyroid Cancer"http://www.thyroidtoday.com/CaseChallenges/LTThyroidCancer1.asp

Hi again - I just want to clarify with you that papillary cancer has been diagnosed and I am currently going through strenghtening my body using iodine, supplements and dietary changes prior to considering the thyroidectomy. So I need to understand how significant the raised level of TSH is in my current condition and what I could/should be doing?

Thanks again

.

[Guest guest]

Thanks Jaki & Sheila for your information,- these are the TF test results

Thyroid function test

Serum free T4 LO 9.0 pmol/L (11.0-22.0) SR

Serum TSH HI 9.3 mU/L (0.10-4.00)SR

Serum free triiodothyronine level 3.7 pmol/L (3.5-6.5)

What's Tg again?

Any advice?

[Guest guest]

Hello - I'm sorry to hear of your diagnosis. I was diagnosed with stage II

follicular thyroid cancer last year and had a total thyroidectomy and lymph

nodes removed.

My cancer was found almost by accident after being told for many years in the UK

that I had a 'normal, healthy' thyroid even though I showed signs of classic

hypothyroidism... but that's water under the bridge and I'm just happy it was

found.

I live in France - I had an ultrasound which detected the enlarged thyroid and

nodules... a week later I had an iodine uptake scan (scintographie in France)

and this detected cold areas on my thyroid. I had several blood tests including

thyroglobulin and antibodies... I saw an endo with all of the results and he

refered to me to the surgeon and a week later it was all done and dusted. The

surgeon told me the following day he thought it was cancer and the biopsy

confirmed this a week later.

I dont understand why you are waiting for your surgery - this is all very new to

me so maybe you could clarify? Are you scheduled for surgery?

I, like others have mentioned, have my TSH supressed. It is essential that this

happens as I dont want any remaining thyroid cells to wake up and risk further

cancer.

I also had 100 millicuries of Radiactive iodine 8 weeks after surgery to kill

off any remaining thyroid/cancer cells.

I will have a blood test and scan every 6 months now - the blood test looks for

thyroglobulin as it is used as a cancer marker - mine is undetectable which is

excellent - if it rises this will flag potential recurrance.

I do hope you get some answers soon and that everything works out well for you -

thyroid cancer is very treatable so good luck and if you have any other

questions feel free to ask (although I'm no expert)

x

[Guest guest]

Hi , These are very poor results, As a result of these has your doc diagnosed you with hypothyroidism and started treatment? Tg-ab is an anti thyroid autoimmune response- the result should be almost/ nil. If it is high, then it indicates that your thyroid is gradually being destroyed. thyroid treatment From: akuziw@...Date: Mon, 9 May 2011 21:50:32 +0100Subject: Re: raised TSH

Thanks Jaki & Sheila for your information,- these are the TF test results

Thyroid function test

Serum free T4 LO 9.0 pmol/L (11.0-22.0) SR

Serum TSH HI 9.3 mU/L (0.10-4.00)SR

Serum free triiodothyronine level 3.7 pmol/L (3.5-6.5)

What's Tg again?

Any advice?

[Guest guest]

Hi - the reason for waiting for surgery is totally my choice, my view is that my body must have been in a real state to get the cancer in the first place and I am a strong believer that if I at least do some work on myself, then should I then go for surgery, and to be honest, I may not have a choice in the end, then I want to be in the best place physically and mentally.

Thanks for your input - I am sending the results to Dr Peatfield and will go from there I think.

[Guest guest]

Thyroglobulin

A bit of a mouthful, but something that patients with thyroid cancer become quickly familiar with, not least because the doctors keep on mentioning it!

Thyroglobulin (or "Tg" to be kinder to the tongue) is a substance made by thyroid cells. This is unique as no other tissue or cell in the body is capable of making Tg

Thyroid cells usually store Tg, but some of it leaks into the blood stream and can be measured in a blood sample. Patients with thyroid cancer who have been cured by surgery and radioiodine, have no detectable Tg in their blood stream.

If the cancer comes back, the Tg blood test becomes positive long before the cancer causes symptoms. So the Tg blood test can be used as a marker of thyroid cancer and it can pick up recurrence and give doctors the opportunity to offer early treatment.

In some patients the Tg blood test takes time to become negative after radioiodine and it may detectable at low levels for a year.

In some cases it can be detectable at low levels for a very long time. What is sometimes difficult to know is whether low levels of Tg in the blood are due to persistent thyroid cancer, or normal thyroid tissue that has not been removed by surgery and radioiodine.

Doctors then may use other tests to try and find out, or simply look for a trend in the levels of Tg over time.

The Tg blood test becomes much more sensitive when there are high levels of the hormone TSH in the circulation. TSH (stands for "thyroid stimulating hormone") comes from the pituitary gland and the levels can be raised either by stopping the thyroxine treatment, or by injections of synthetic TSH (Thyrogen).

TSH seems to be able to "squeeze" Tg out of thyroid cells, so in some cases where there are microscopic amounts of thyroid cancer in the body, the Tg can be detected only after the blood levels of TSH are raised.

Tg is a useful tool in monitoring most patients with thyroid cancer. Sometimes however, patients and doctors (particularly if inexperienced) can get carried away in chasing the slightly raised Tg result with excessive investigations that usually generate a lot of anxiety and hardly ever yield any valuable information.

Tg monitoring is only part of how patients with thyroid cancer should be managed, and needs to be put in context of the individual case.

This is why these days such decisions are taken after careful consideration and discussion among the thyroid cancer experts in multi-disciplinary team meetings.

So, if your Tg result is negative it is reassuring news, but if it is detectable my advice is: don’t try to interpret the result yourself; ask your specialist to explain what that means in your individual case.

Petros PerrosConsultant EndocrinologistJoint Thyroid Cancer ClinicNorthern Centre for Cancer Care Newcastle upon Tyne

http://www.butterfly.org.uk/about.htm

Thanks Jaki & Sheila for your information,

- these are the TF test results Thyroid function test

Serum free T4 LO 9.0 pmol/L (11.0-22.0) SR

Serum TSH HI 9.3 mU/L (0.10-4.00)SR

Serum free triiodothyronine level 3.7 pmol/L (3.5-6.5)

What's Tg

again?

Any advice?

[Guest guest]

What brought about your diagnosis of Papillary Cancer to begin with?

Hi - the reason for waiting for surgery is totally my choice, my view is that my body must have been in a real state to get the cancer in the first place and I am a strong believer that if I at least do some work on myself, then should I then go for surgery, and to be honest, I may not have a choice in the end, then I want to be in the best place physically and mentally.

Thanks for your input - I am sending the results to Dr Peatfield and will go from there I think.

[Guest guest]

Hi again

My diagnosis came about when I saw a lump in my throat whilst brushing my teeth! I monitored it for a while and then went to the GP who organised a specialist visit with ultrasound and biopsy at which point it was diagnosed.

I have had thermography scans on it since to monitor it and see what activity there is and am waiting for the results of the latest one to compare against October 2010.

Re: Tg - it looks like this wasn't tested as my blood results don't mention it - is this something I should be asking for now?

[Guest guest]

You should ask for TPO and TgAb to be tested

Luv - Sheila

Re: Tg - it looks like this

wasn't tested as my blood results don't mention it - is this something I should

be asking for now?