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What Do My Lab Test Reports Indicate?
Question: Dear Doctor , I hope you are doing will. Please find the attachment for my brother case , he did thyroidectomy two weeks ago.
Please kindly let me know
1- His pathology report and how is ( cauterized, they mention in the hospital it is capsulized ) would impact his chance for treatment
2- what is the possible treatment ?
3-What are the chances that his cancer will recur?
4- how long do you think he will survive?
5- is he ow risk cancer or high risk cancer?
6- what the next step XXXXXXX doasge 30 with WBS or only ultra sound on the neck with blood test?
Thanks in advance and best regards
xxxx
Please kindly let me know
1- His pathology report and how is ( cauterized, they mention in the hospital it is capsulized ) would impact his chance for treatment
2- what is the possible treatment ?
3-What are the chances that his cancer will recur?
4- how long do you think he will survive?
5- is he ow risk cancer or high risk cancer?
6- what the next step XXXXXXX doasge 30 with WBS or only ultra sound on the neck with blood test?
Thanks in advance and best regards
xxxx
Brief Answer:
Excellent prognosis:
Detailed Answer:
Hello,
I have gone carefully through your attached results and understand your concern regarding to your brother's health.
I would say that it is a good news that the big nodule is not malignant.
The nodule resulted to be malignant are too small and in these cases total thyroidectomy is the definite treatment.
Papillary infracentimetric cancers have an excellent prognosis and many guidelines suggest that radioiodine treatment is not needed.
The chances to recur are very very low (if the thyroid is totally resected) and the survival is not effected.
So, you should get not worried because is a a type of cancer with excellent prognosis (especially if infracentimetric).
Hope the information will help.
Kind regards,
Dr.Mirjeta
Excellent prognosis:
Detailed Answer:
Hello,
I have gone carefully through your attached results and understand your concern regarding to your brother's health.
I would say that it is a good news that the big nodule is not malignant.
The nodule resulted to be malignant are too small and in these cases total thyroidectomy is the definite treatment.
Papillary infracentimetric cancers have an excellent prognosis and many guidelines suggest that radioiodine treatment is not needed.
The chances to recur are very very low (if the thyroid is totally resected) and the survival is not effected.
So, you should get not worried because is a a type of cancer with excellent prognosis (especially if infracentimetric).
Hope the information will help.
Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Doctor,
I hope you are doing well. Thanks a lot for your professional opinion and your capabilities . Since we do not have such qualified doctor in our area , Kindly please answer the following questions:
1-Is this really multi focal cancer should be treat it as aggressive cancer?
2- is my brother' cancer consider high risk because it is multifocal or low risk cancer?
3- if Very low risk is (1- Microcarcinoma: unifocal or multicentric Stage I [T0–T2 (s,m) N0 M0]; MACIS <6 )
Low risk ( 2- Tumor <4cm confined to the thyroid (no LN involvement) Stage II [T2, N0, M0]; MACIS <6)
Moderate risk 3- Histologic subtype conferring increased risk (hurthle cell, insular, sclerosing, tall cell, etc.) Minimally (i.e. microscopic) invasive follicular ca <4 cm )
What exactly his case very low , low or Moderate risk ( if hopefully no distant metastasis ) ???
4- What the chance of distant metastasis in this case ?
5-is that really chance His Tg Blood test being zero or undetectable after 4-6 weeks?
Really appreciated your answer and your help.
Best Regards
xxxxx
I hope you are doing well. Thanks a lot for your professional opinion and your capabilities . Since we do not have such qualified doctor in our area , Kindly please answer the following questions:
1-Is this really multi focal cancer should be treat it as aggressive cancer?
2- is my brother' cancer consider high risk because it is multifocal or low risk cancer?
3- if Very low risk is (1- Microcarcinoma: unifocal or multicentric Stage I [T0–T2 (s,m) N0 M0]; MACIS <6 )
Low risk ( 2- Tumor <4cm confined to the thyroid (no LN involvement) Stage II [T2, N0, M0]; MACIS <6)
Moderate risk 3- Histologic subtype conferring increased risk (hurthle cell, insular, sclerosing, tall cell, etc.) Minimally (i.e. microscopic) invasive follicular ca <4 cm )
What exactly his case very low , low or Moderate risk ( if hopefully no distant metastasis ) ???
4- What the chance of distant metastasis in this case ?
5-is that really chance His Tg Blood test being zero or undetectable after 4-6 weeks?
Really appreciated your answer and your help.
Best Regards
xxxxx
Brief Answer:
About papillary microcarcinoma:
Detailed Answer:
Welcome back!
Even though it is multifocal it is considered low risk. As i explained before, the lesions are too small and is a type with good prognosis.
The chance of distant metastasis is almost nil.
If a good intervention is done, thyroglobuline should be undetectable after 2 months.
Wish him good health.
Regards,
Dr.Mirjeta
About papillary microcarcinoma:
Detailed Answer:
Welcome back!
Even though it is multifocal it is considered low risk. As i explained before, the lesions are too small and is a type with good prognosis.
The chance of distant metastasis is almost nil.
If a good intervention is done, thyroglobuline should be undetectable after 2 months.
Wish him good health.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor, Thanks a lot for your reply. Could you please advise when shall he do the Tg test after 4 weeks or two month? Now he is taking the Levothiroxine , so can we make the Tg blood test during he is taking the tablets or shall we stop and give him thyrogen injection to get the result of Tg ?? Pls advice. With my best regards from Doha xxxxx
Brief Answer:
About thyroglobuilne level:
Detailed Answer:
Hello again,
Usually a 4 week period after thyroidectomy is useful to eliminate the pre-operatory thyrogobuline.
Low serum Tg levels during TSH suppression (Tg
<0.2 ng/mL) or after stimulation (Tg <1 ng/mL) in the absence of interfering antibodies (AntiTg antibodies) is a criteria for absence of persistant tumor.
So, it should be checked under levothyroxine treatment and after stimulation with Thyrogen (or withdrawl of levothyroxine for 4 weeks).
For a detailed information you may read the latest guideline of diagnosis and treatment of paplillary cancer:
http://online.liebertpub.com/doi/pdf/10.1089/thy.2015.0020
Regards,
Dr.Mirjeta
About thyroglobuilne level:
Detailed Answer:
Hello again,
Usually a 4 week period after thyroidectomy is useful to eliminate the pre-operatory thyrogobuline.
Low serum Tg levels during TSH suppression (Tg
<0.2 ng/mL) or after stimulation (Tg <1 ng/mL) in the absence of interfering antibodies (AntiTg antibodies) is a criteria for absence of persistant tumor.
So, it should be checked under levothyroxine treatment and after stimulation with Thyrogen (or withdrawl of levothyroxine for 4 weeks).
For a detailed information you may read the latest guideline of diagnosis and treatment of paplillary cancer:
http://online.liebertpub.com/doi/pdf/10.1089/thy.2015.0020
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Doctor Mirjeta,
I hope you are doing well , as usual we need your help, The lab test for my brother just receive it now, I think it is bad .
The Alkaline phosphate ALP Increased from 108 to 286 within one week from 7 march to 15 march .
and his calcium level as of today 15/3/2017 is 10.5 which is high . please note that his calcium level during and after surgery was 9.2, 9 and 8.8 with reference range of 8.4 to 10.20) on 17.18 and 19 February ,please explain to me frankly is it metastasis or parathyroid cancer or something else. thanks in advance and best regards
xxxxx
I hope you are doing well , as usual we need your help, The lab test for my brother just receive it now, I think it is bad .
The Alkaline phosphate ALP Increased from 108 to 286 within one week from 7 march to 15 march .
and his calcium level as of today 15/3/2017 is 10.5 which is high . please note that his calcium level during and after surgery was 9.2, 9 and 8.8 with reference range of 8.4 to 10.20) on 17.18 and 19 February ,please explain to me frankly is it metastasis or parathyroid cancer or something else. thanks in advance and best regards
xxxxx
Brief Answer:
About high calcium level;
Detailed Answer:
Hello again,
High calcium level associated with high ALP is suggestive for osteolytic lesions but a parathormone level would be of help in these cases.
If it results high, the origin is very likely to be from parathyroid overproduction(even though can not be so acute and the surgeon should have checked the parathyroid glands during the intervention and would have noticed any enlargement)
Otherwise a bone lesion is probable.
Anyway, they should be checked in dynamic and if there is a tendency to get increased a PTH related peptide would be of help.
Regards,
Dr.Mirjeta
About high calcium level;
Detailed Answer:
Hello again,
High calcium level associated with high ALP is suggestive for osteolytic lesions but a parathormone level would be of help in these cases.
If it results high, the origin is very likely to be from parathyroid overproduction(even though can not be so acute and the surgeon should have checked the parathyroid glands during the intervention and would have noticed any enlargement)
Otherwise a bone lesion is probable.
Anyway, they should be checked in dynamic and if there is a tendency to get increased a PTH related peptide would be of help.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Doctor, thanks alot for your reply.
Can also using Levothyroxine dosage of 150 5 days and 2 days 200 increase blood calcium to be like or not ???
Regards
xxxxx
Can also using Levothyroxine dosage of 150 5 days and 2 days 200 increase blood calcium to be like or not ???
Regards
xxxxx
Brief Answer:
Yes, hyperthyroidism may cause high calcium levels:
Detailed Answer:
Yes, hyperthyroidism may cause elevation of calcium levels, but a 4-6 weeks of treatment with high doses of levothyroxine is needed to cause factitious hyperthyroidism.
The PTh level will give further information regarding to the cause of hypercalcemia. Anyway, a dynamic follow up is mandatory.
Regards,
Dr.Mirjeta
Yes, hyperthyroidism may cause high calcium levels:
Detailed Answer:
Yes, hyperthyroidism may cause elevation of calcium levels, but a 4-6 weeks of treatment with high doses of levothyroxine is needed to cause factitious hyperthyroidism.
The PTh level will give further information regarding to the cause of hypercalcemia. Anyway, a dynamic follow up is mandatory.
Regards,
Dr.Mirjeta
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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