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Old 05-05-2006, 01:47 PM   #1
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Saw Endo--lab results

My endo runs only three tests, TSH, Free T4 and Thyroglobulin. I picked up a copy of the results at my appointment this afternoon.

TSH-- 0.33 reference range 0.34-5.50
Free T4--1.115 ref. range 0.580-1.64
ThyrGlb--3.9 ref. range 2.0-35.0


The only result that seemed to be of concern was the Thyroglobulin; unless I misunderstood he said it was higher than he had hoped for (he's a feriner and doesn't talk right ). When I asked the significance he said it suggested some remaining thyroid tissue may be lurking.

The upshot is that he increased my Synthroid from 200 to 225mcg. At first he was going to 250 but after asking my age (I'm 58) he changed it to 225. I have no idea why my age matters but apparently it does.

He's going to follow up again in two months, then schedule an I-131 scan.

If any of you more experienced people could comment and help me understand what the numbers mean I would appreciate it. Also, are these three tests adequate for someone with a dx of t-cancer, a TT and RAI?

BTW-the endo mentioned that my GP had phoned and asked about me. I saw the GP on Monday but he took the time to inquire of the endo. That one is definitely a keeper.

 
Old 05-06-2006, 05:43 AM   #2
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Re: Saw Endo--lab results

Hi Archie, mostly bumping up for you since I don't have experience with T-cancer. Glad he gave you a little boost - better than none! I think the docs think anyone over 50-55 don't need as much meds as the younger people. I think it could depend on how active you are, but I guess not. I am WAY more active than either of my girls (ages 28 & 39 this yr), however my son, at 43 beats us all!!

The Thyroglobulin test- I looked it up and yes, it suggests some remaining thyroid tissue.

YES, keep than GP!!! BTW - where are you located? I may need him!
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Old 05-07-2006, 05:20 AM   #3
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Re: Saw Endo--lab results

I'm in Savannah GA. This GP came highly recommended and he has exceeded expectations. Definitely a keeper. I believe he could be convinced to take over for the endo and do a jam up job, if pressed into that role. He listens and asks questions like a detective with a murder suspect.

The TG level, indicating some remaining T tissue, is a little worrisome but would be consistent with the convervative approach the T surgeon said he uses. He told me he will opt to leave small amounts rather than risk damage to other things in the vicinity. The RAI should have killed it, though.

 
Old 05-07-2006, 05:42 AM   #4
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Re: Saw Endo--lab results

Way too far for me! I'm near Kansas City. I think we went by Savannah on our way home from FL on 95 one time.

So, the I-131 scan detects if there is thyroid left? If there is (as the Thyroglobulin test shows) what do they do then? Could the amt of RAI not been quite enough to kill it all? Could it still be working on killing it? Not sure how all this works.

Once you get all of this out of the way, this doc may be the one you want to take care of the hypo. Some GP's are way better than some Endo's.
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Old 05-07-2006, 06:29 AM   #5
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Re: Saw Endo--lab results

Hi Archie,

In terms of the age, my uneducated guess is it may be a heart related issue. He obviously wants to get your TSH suppressed, but in my case, my endo wants it very suppressed, less than .01, and in your case, because of your age, he's worried that if you get too much hormone, you may be at risk for high blood pressure/stroke (too much T3 in your body). See how you feel with the higher dose in six weeks---I have a feeling you won't be needing that nap time anymore.

In terms of the slightly high thyroglobulin---2 things,
1--how far out from your RAI are you? It works about 3-4 months after you take the pill, so it's probably still working to kill tissue.
2-You weren't hypo when you took the test right?

My endo. took the same test a couple of months out. It was slightly higher than he expected, but when I pressed him about it, he said since I wasn't hypo when I took the test, and not that far out from RAI, it was really some sort of "baseline"???

A year later, when I went for my follow up scan and was on thyrogen to mimic a high TSH, the scans and the blood work thank God were clear.

The thyroglobulin thing confuses me a lot...I understand it conceptually, but when I was tested for it at the same point you were, I couldn't understand why it was done, and I'm glad it turned out to be irrelevant.

Hopefully your follow up scans will be perfect....

 
Old 05-07-2006, 06:58 AM   #6
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Re: Saw Endo--lab results

The RAI was on Feb. 23rd so it still has some work to do I guess.

Was I hypo at time of test? I assume you mean when the blood was drawn and I'm not sure I know the answer. I was (and still am) having some hypo symptoms but not nearly as bad as 4-6 weeks ago. Based on the THS done at this test I was NOT hypo, slightly suppressed, actually.

You're right--this is all pretty confusing. I'm sure my endo could explain it if he wanted to take the time (and thought I would understand) but he doesn't. He, too, came highly recommended but seems rushed at every appointment except the first. My preconception of him as a prima donna was disspelled after the first appointment; now he just comes across as very busy.

My biggest concern is that the follicular cancer may have found a foothold in a lung. All xrays taken during the run-up to surgery showed them clear--just the single metastasis site in the rib. But since follicular does affect the lungs on rare occasions it will probably always be a nagging concern.

 
Old 05-07-2006, 07:14 AM   #7
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Re: Saw Endo--lab results

Archie - so glad the RAI is still working - thanks, Reece for explaining that!
It sounds as if your doc knows what he is doing, even if he isn't taking a lot of time with you now. Glad your lungs are clean, that is GOOD! Keep us posted on everthing that is going on.

Reece - so T3 is something I have to watch getting too much of because of my age? My BP is usually low - still is, but my HR seems to have gone up, especially when I eat, it seems.
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Old 05-07-2006, 09:52 AM   #8
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Re: Saw Endo--lab results

Archie---for the "real" thyroglobulin follow ups, I think they want the TSH all the way high, like you had it for RAI---so I think my 1 year follow up thyrogen thyroglobulin test was more accurate/informative than the one the endo. had done a couple of months after RAI while I was on synthroid. ---- You're doing everything right, you've done what the doctors say, so now, you just gotta live life and enjoy by pushing those yucky thoughts away....it ain't easy.

illmakeit---T3---and T4 which converts to T3, definitely affects your entire metabolism---including your heart. Now that my TSH is suppressed, my blood pressure, which was low, is now on the higher side.

That's why endos don't like to give high doses of synthroid or cytomel....if a patient goes up in dose too fast, or if the patient is overdosed, the risk is stroke. That's why self medicating with thyroid meds can be dangerous. Doctors really have to monitor the blood levels, as well as how you feel.

 
Old 05-07-2006, 11:27 AM   #9
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Re: Saw Endo--lab results

About the thyrogen--without me saying anything about it my endo volunteered that he would not be putting me on thyrogen prior to the I-131 scan, just taking me off Synthroid. I guess that means he's one of those old-fashioned doctors who doesn't know what it's like to go deep hypo, or doesn't care.

I am actually the optimistic sort, so even though I may think of bad outcomes I don't dwell on them. I refuse to. I'm a strong believer in fate, life, and death. I'll do anything in reason to prolong the inevitable but will face the fates whatever they deal out. I also have a morbid sense of humor--witness the explanation of what my surgery was going to entail when a friend emailed me for details: I told her the rib butcher was going to his dirty work first, and, if I survived that the neck doctor was going to come in and slit my throat. She replied to say I was bad, bad, bad, and that she laughed so hard she wet her pants.

 
Old 05-07-2006, 12:55 PM   #10
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Re: Saw Endo--lab results

My endo. actually said no to thyrogen --- said my nodule was too large---(also, I had the post Whole Body scan 3 days after the RAI, so I had to wait a year for follow up)

In other countries, they use it routinely, and it is only approved for scans in the US, not treatment. It's 93% as effective as going hypo. So here, I think they shy away from it in more aggressive cancer situations.

I didn't beg, because I wanted to do whatever it took to do the right thing---like you. But when he was writing the scrip. for the scan, he just felt so bad for me, because it took so long to get me to a good dosage. So based upon his sympathies, he changed his mind.

The nuclear medicine place, however, also had to approve it and check my files too.

Maybe you'll be able to do it next year!

Wishing you good health!

 
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