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What Does The Following Test Report Indicate?
Question: Dear Doctor
I hope this find you well . it seems I need you help always and hope it is fine with you.
Doctor could you answer me for the question which is very difficult for my brother case . please find the attachments.
1- In the pathology report is the tumor encapsulated or non - encapsulated??
2- is it shown Positive margin or free margin ??
could you explain in details pls. thanks in advance
Best regards
XXXX
I hope this find you well . it seems I need you help always and hope it is fine with you.
Doctor could you answer me for the question which is very difficult for my brother case . please find the attachments.
1- In the pathology report is the tumor encapsulated or non - encapsulated??
2- is it shown Positive margin or free margin ??
could you explain in details pls. thanks in advance
Best regards
XXXX
Brief Answer:
The prognosis for Papillary Thyroid Cancer is very very good.
Detailed Answer:
Hello XXXX
I have gone through your report.
Papillary Thyroid Cancer or Carcinoma is the most common type of thyroid cancer. It is more commonly seen in middle-aged adults
A subtype of papillary thyroid carcinoma that is totally surrounded by a fibrous capsule is designated an encapsulated carcinoma.In this subtype of thyroid carcinoma the locaregional and distant metastasis,usually, are rare.
In the report show that all the tumor is limited in the thyroid gland.This means that very probably the tumor is encapsulated papillary thyroid carcinoma and it is not shown positive margins.
This is a very good result because this type of thyroid tumor(especially in in lower-stage like in your brother's case) can be removed completely with adequate margins and has a perfect prognosis.So,don't worry.
Anyway,careful and constant postoperative follow-up is recommended.
As with any tumor, it is important to have follow-up appointments with a physician to monitor for any returning tumors.
Hope i have clarified your doubts.
If you have other questions,feel free and ask.
Wish you all the best.
The prognosis for Papillary Thyroid Cancer is very very good.
Detailed Answer:
Hello XXXX
I have gone through your report.
Papillary Thyroid Cancer or Carcinoma is the most common type of thyroid cancer. It is more commonly seen in middle-aged adults
A subtype of papillary thyroid carcinoma that is totally surrounded by a fibrous capsule is designated an encapsulated carcinoma.In this subtype of thyroid carcinoma the locaregional and distant metastasis,usually, are rare.
In the report show that all the tumor is limited in the thyroid gland.This means that very probably the tumor is encapsulated papillary thyroid carcinoma and it is not shown positive margins.
This is a very good result because this type of thyroid tumor(especially in in lower-stage like in your brother's case) can be removed completely with adequate margins and has a perfect prognosis.So,don't worry.
Anyway,careful and constant postoperative follow-up is recommended.
As with any tumor, it is important to have follow-up appointments with a physician to monitor for any returning tumors.
Hope i have clarified your doubts.
If you have other questions,feel free and ask.
Wish you all the best.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Doctor , Thanks a lot for your very qualified opinion, really appreciated.
So do you think XXXXXXX , whole body scan are needed or Ultra sound would be enough?
Thanks alot
XXXX
So do you think XXXXXXX , whole body scan are needed or Ultra sound would be enough?
Thanks alot
XXXX
Brief Answer:
I can say that XXXXXXX are not necessary in this case.
Detailed Answer:
Hello XXXX
The follow up for a multifocal papilary thyroid carcinoma with foci<1cm(like in your brother's case) may include neck ultrasound and whole body scan to identifie residual disease.
XXXXXXX ablation is not recommended because all the tumor foci are < 1 cm.
Last thing: It is very important a lifelong thyroid hormone replacement therapy, especially after total thyroidectomy. Treatment consists of levothyroxine in a dosage of 2.5-3.5 mcg/kg/d,to maintain the TSH at or slightly below the lower-normal limit.
Hope my information is helpful.
If you have other doubts,feel free and ask.I will be happy to help.
Take care.
I can say that XXXXXXX are not necessary in this case.
Detailed Answer:
Hello XXXX
The follow up for a multifocal papilary thyroid carcinoma with foci<1cm(like in your brother's case) may include neck ultrasound and whole body scan to identifie residual disease.
XXXXXXX ablation is not recommended because all the tumor foci are < 1 cm.
Last thing: It is very important a lifelong thyroid hormone replacement therapy, especially after total thyroidectomy. Treatment consists of levothyroxine in a dosage of 2.5-3.5 mcg/kg/d,to maintain the TSH at or slightly below the lower-normal limit.
Hope my information is helpful.
If you have other doubts,feel free and ask.I will be happy to help.
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor , thanks a lot for your kind and professional reply , could you please clarify pls , because our doctor inform us that , every cauterize tomer should be positive margin if the pathology report mention , at linked posterior of thyriod , is it right ? Thanks and best regaras
Brief Answer:
Yes,it is right.
Detailed Answer:
Hi again XXXX
It is right,every cauterize tumor should be positive margin.
Depending upon what the pathologist sees, the margins of a tumor are described as: Positive margins if Cancer cells extend out to the edge of the tissue, where the ink is and Negative margins when No cancer cells are found in the ink.
In your brother's patology report is not mentioned if the margins of tumor are positive or negative but (as i said earlier) all the tumor is limited to the thyroid gland and the foci are small(<1cm),for this reason i can deduce that the camcer cells are not extended aou of the edge of the thyroid tissue.
Anyway my advice is to talk with the anatomic pathologist who did the microscopic examination of the tissue.
Hope my information is helpful.
Wish you good health.
Yes,it is right.
Detailed Answer:
Hi again XXXX
It is right,every cauterize tumor should be positive margin.
Depending upon what the pathologist sees, the margins of a tumor are described as: Positive margins if Cancer cells extend out to the edge of the tissue, where the ink is and Negative margins when No cancer cells are found in the ink.
In your brother's patology report is not mentioned if the margins of tumor are positive or negative but (as i said earlier) all the tumor is limited to the thyroid gland and the foci are small(<1cm),for this reason i can deduce that the camcer cells are not extended aou of the edge of the thyroid tissue.
Anyway my advice is to talk with the anatomic pathologist who did the microscopic examination of the tissue.
Hope my information is helpful.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor Elona, Thanks a lot for your reply. So finally my brother contact the pathology Doctor Which provide some information , which difficult for me understand , I hope u could clarify please , if there is remains cancer due fin margin or clear . Best regards XXXX
Brief Answer:
I have just read your last report.
Detailed Answer:
Hello XXXX
I read carefully the response of your brother's anatomic pathologist.
He mention the possibility of residual tumor tissue in the left thyroid bed.
Generally after the total thyroidectomy for thyroid tumor,it is recommended to do a XXXXXXX Whole Body Scan and the serum TG level.
This tests give the information if there is residual thyroid tissue after the total thyroidectomie.
From your first report ,i can read that the tumor was at minimum pathologic stage:T1aNxMx and all limited to the thyroid gland.So,i deduced that it was possible to remove it in clear margins.
Anyway,if you want to be sure if there is residual tissue or not the only way is to to the WBS after 4 weeks of thyroidectomy and serum TG/anti TG level.
Hope i have answered to your question.
Thank you for using HCM.
Best regards.
Regards.
I have just read your last report.
Detailed Answer:
Hello XXXX
I read carefully the response of your brother's anatomic pathologist.
He mention the possibility of residual tumor tissue in the left thyroid bed.
Generally after the total thyroidectomy for thyroid tumor,it is recommended to do a XXXXXXX Whole Body Scan and the serum TG level.
This tests give the information if there is residual thyroid tissue after the total thyroidectomie.
From your first report ,i can read that the tumor was at minimum pathologic stage:T1aNxMx and all limited to the thyroid gland.So,i deduced that it was possible to remove it in clear margins.
Anyway,if you want to be sure if there is residual tissue or not the only way is to to the WBS after 4 weeks of thyroidectomy and serum TG/anti TG level.
Hope i have answered to your question.
Thank you for using HCM.
Best regards.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor , I hope you are doing well. I got me lab test today for my brother Anti Tg is 74.06 and range is 0,00 - 4,11 and tg is 0,07 and range 1,4 to 78 ( anti-tg may falsely decrease tg level) .please be noted that is he is using now levothyroxine tablet . Please advise me asap. Best regzrds
Brief Answer:
In this case the Tg level is unreliable.
Detailed Answer:
Hello and thanks for asking.
Following therapy of differentiated follicular-cell derived thyroid cancer, patients with no residual thyroid tissue and no persistent or recurrent cancer will have undetectable or very low serum Tg levels.
In your brother's case the level of TG is very very low and this is a good think because persistently elevated or rising serum Tg levels, either on or off thyroxine replacement therapy, suggest possible tumor persistence or recurrence.
At the other side,it is true that, if a patient also has measurable anti-Tg autoantibody levels, the results of serum Tg measurements may be unreliable. Anti-Tg may result in both falsely-low serum Tg measurements.
Therefore, in anti-Tg-positive patients, serum Tg measurements should not be used as the sole measurement for thyroid cancer follow-up and should be interpreted with caution.
It is recommended that the thyroglobulin result be reviewed for concordance with clinical presentation and with WBS result.
So,to resume:Your brother has a high level of anti-Tg and this make the Tg level to read artificially low. In these cases, the antibodies levels themselves can be monitored and should become undetectable, in most patients with no evidence of disease, by 3-5 years after diagnosis.
For this reason the follow up will be done with:
-Thyroid scan (radioactive iodine whole-body scan) either after thyroid hormone withdrawal
-Neck Ultrasound. This test is increasingly used, because it is a very sensitive way to find disease in the neck.
-Blood testing for TSH (thyroid stimulating hormone). Often, this is done about every 3 to 6 months during the first few years after diagnosis and less frequently later on.
-Physical Examination.9for this it is important to meet the treating endocrinologist) Typically, this is done every 3 to 6 months for the first 2 years and then once a year if there is no recurrence of the thyroid cancer.
Hope this information is helpful.
Thanks for using HCM.
Wish you good health.
In this case the Tg level is unreliable.
Detailed Answer:
Hello and thanks for asking.
Following therapy of differentiated follicular-cell derived thyroid cancer, patients with no residual thyroid tissue and no persistent or recurrent cancer will have undetectable or very low serum Tg levels.
In your brother's case the level of TG is very very low and this is a good think because persistently elevated or rising serum Tg levels, either on or off thyroxine replacement therapy, suggest possible tumor persistence or recurrence.
At the other side,it is true that, if a patient also has measurable anti-Tg autoantibody levels, the results of serum Tg measurements may be unreliable. Anti-Tg may result in both falsely-low serum Tg measurements.
Therefore, in anti-Tg-positive patients, serum Tg measurements should not be used as the sole measurement for thyroid cancer follow-up and should be interpreted with caution.
It is recommended that the thyroglobulin result be reviewed for concordance with clinical presentation and with WBS result.
So,to resume:Your brother has a high level of anti-Tg and this make the Tg level to read artificially low. In these cases, the antibodies levels themselves can be monitored and should become undetectable, in most patients with no evidence of disease, by 3-5 years after diagnosis.
For this reason the follow up will be done with:
-Thyroid scan (radioactive iodine whole-body scan) either after thyroid hormone withdrawal
-Neck Ultrasound. This test is increasingly used, because it is a very sensitive way to find disease in the neck.
-Blood testing for TSH (thyroid stimulating hormone). Often, this is done about every 3 to 6 months during the first few years after diagnosis and less frequently later on.
-Physical Examination.9for this it is important to meet the treating endocrinologist) Typically, this is done every 3 to 6 months for the first 2 years and then once a year if there is no recurrence of the thyroid cancer.
Hope this information is helpful.
Thanks for using HCM.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Doctor, thanks a lot for your reply . So if the anti ag comes to be undecteable does it mean free of cancer? If yes is there any chance for him to be free after XXXXXXX treatment ? And if he had tissue and I believe that is sure can it be treat it ? Based in that do he is still low risk ?? Last is anti is prognisis factor or no? Best regards for you XXXX
Brief Answer:
Don't worry,the anti-thyrogloblin antibodies are not harmful.
Detailed Answer:
Hi XXXX
I appologise for the late response.
Yes,if the anti-TG and the TG levels are undetectable or very very low,and there are no evidence of thyroid tissue in the WBS result and no neck lymph nodes for several months or 1 year,this mean that your bro is free of cancer.
2.yes,it has very good chances to be free after Radioiodine Ablation and this is the way how the recurrent thyroid tissue will be eliminated,if the disease will persist.
3.Based on what we have discussed several time earlier,your brother is low risc and even if will have some thyroid cells/tissue that persist,this will be detected by The WBS and eliminated with RIA.
4.No,the anti TG antibodies are not a prognostic factor for PTC patients.So,don't worry.We have said lots of time that the prognosis for PTC is very very good.
Hope i have answer to your questions.
Regards.
Don't worry,the anti-thyrogloblin antibodies are not harmful.
Detailed Answer:
Hi XXXX
I appologise for the late response.
Yes,if the anti-TG and the TG levels are undetectable or very very low,and there are no evidence of thyroid tissue in the WBS result and no neck lymph nodes for several months or 1 year,this mean that your bro is free of cancer.
2.yes,it has very good chances to be free after Radioiodine Ablation and this is the way how the recurrent thyroid tissue will be eliminated,if the disease will persist.
3.Based on what we have discussed several time earlier,your brother is low risc and even if will have some thyroid cells/tissue that persist,this will be detected by The WBS and eliminated with RIA.
4.No,the anti TG antibodies are not a prognostic factor for PTC patients.So,don't worry.We have said lots of time that the prognosis for PTC is very very good.
Hope i have answer to your questions.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor , thanks a lot for your reply . We discuss with the pathologiest and he confirmed that my brother has positive maragin, so due in that do you think now he is in high risk and not like before in low risk ?? And with that positive margin , does it mean tissue or cells left , please advise? Best regards XXXX
Brief Answer:
Yes,possive margins means cells left.
Detailed Answer:
Dear XXXX
High Risk means extensive tumor outside the thyroid, distant metastases, or other high-risk factors like increasing tumor size for FTC , age > or =45 years or widely invasive tumor growth.
According to your reports ,your brother has not these risc factors.
Regards.
Yes,possive margins means cells left.
Detailed Answer:
Dear XXXX
High Risk means extensive tumor outside the thyroid, distant metastases, or other high-risk factors like increasing tumor size for FTC , age > or =45 years or widely invasive tumor growth.
According to your reports ,your brother has not these risc factors.
Regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Doctor , thanks a lot for your reply , will update you day after tomorrow about his WBS , my question does the positive margin consider as Incompleted resaction??? And the residual tissues as well??? Best regard XXXX
Brief Answer:
Positive margins can not be considered incomplete resection.
Detailed Answer:
Hello XXXX
Guidelines for treatment of differentiated thyroid cancer (DTC) recommend total thyroidectomy because complete resection of the entire gland resulted in improved the prognosis and lower recurrence rates.
If your brother has done total thyroidectomy,this means that his surgeon has done a complete thyroid resection.Positive margins can be because maybe there are only some tumor cells left and this can happens even in complete resection.
If there are residual tissue left after the total thyroidectomy(that can be seen in ultrasound),this means that the surgeon has not resected all the thyroid gland.This is incomplete resection.
Let me know the WBS result.After the result we can discuss about the follow up.
Hope i have clarified your doubts.
Regards.
Positive margins can not be considered incomplete resection.
Detailed Answer:
Hello XXXX
Guidelines for treatment of differentiated thyroid cancer (DTC) recommend total thyroidectomy because complete resection of the entire gland resulted in improved the prognosis and lower recurrence rates.
If your brother has done total thyroidectomy,this means that his surgeon has done a complete thyroid resection.Positive margins can be because maybe there are only some tumor cells left and this can happens even in complete resection.
If there are residual tissue left after the total thyroidectomy(that can be seen in ultrasound),this means that the surgeon has not resected all the thyroid gland.This is incomplete resection.
Let me know the WBS result.After the result we can discuss about the follow up.
Hope i have clarified your doubts.
Regards.
Above answer was peer-reviewed by :
Dr. Prasad
Hi again doctor, thanks a lot for your reply , he did today the WBS and will provide you with result tommorw . We get the result of lab test for TSH after thyrogen injections and the level is 68,731 and the range 0,350-4,949 is that really high and is that also related to the case ??? The result of Anti-TG today is 67,66 and the rang is 0,00 to 4,11 and last Monday was 74,06 and he strated the dosage of 30 XXXXXXX 2 days ago . Please explain finals Tg is 1,32 and the range is 1,40- 78 , I hope you can provide us with your view. Thanks and best regards XXXX
Dear Doctor , I hope you are doing well . Based on my last questions , do you think anti TG reduced due to thyrogen injections or due to XXXXXXX treatment , pls advise. Thanks in advance and best regards
Dear Doctor , I hope you are doing well . Based on my last questions , do you think anti TG reduced due to thyrogen injections or due to XXXXXXX treatment , pls advise. Thanks in advance and best regards
Brief Answer:
No,The anti-TG can't be reduced by Thyrogen or XXXXXXX treatement.
Detailed Answer:
Hello XXXX
I have carefully gone through your brother's results.
He has high level of TSH,
Low TG
High anti-TG.
The Thyrogen injection is very important after total thyroidectomy for thyroid tumor for two reason: to avoid hypothyroidism (underactive thyroid condition) and to prevent growth or recurrence of thyroid cancer.
Usually the T4 dose is large enough to suppress blood level of thyroid stimulating hormone (TSH) below the normal TSH range.
In your brother's case the thyrogen injection has not yet suppresed the TSH.
This means that maybe the dose is not enough.The recommended dosage is 2.5-3.5 mcg/kg/d and the TSH should be rechecked after 6 weeks.
My advice for you in these circumstances is to talk with your brother's endocrinologist about the necessary dose adjustment of levothyroxine.
About the TG ,anti-TG as we heve discussed several times,The high level of anti-Tg makes unreliable the low level of TG.
TGab antibodies cannot be managed or controlled in any way. They rise or fall, and the only way to lower them with therapy is to suppress your immune system. Suppressing your immune system is not a good thing to do, so there is no practical treatment for those antibodies.
But i want to say the the XXXXXXX treatement will eliminate all the residual thyroid tissue and with the adequate dose of thyrogen,the situation will be under control.So,(as i said lots of times in our discussion ,don't worry because the prognosis is very good.
Hope this is helpful.
Regards.
No,The anti-TG can't be reduced by Thyrogen or XXXXXXX treatement.
Detailed Answer:
Hello XXXX
I have carefully gone through your brother's results.
He has high level of TSH,
Low TG
High anti-TG.
The Thyrogen injection is very important after total thyroidectomy for thyroid tumor for two reason: to avoid hypothyroidism (underactive thyroid condition) and to prevent growth or recurrence of thyroid cancer.
Usually the T4 dose is large enough to suppress blood level of thyroid stimulating hormone (TSH) below the normal TSH range.
In your brother's case the thyrogen injection has not yet suppresed the TSH.
This means that maybe the dose is not enough.The recommended dosage is 2.5-3.5 mcg/kg/d and the TSH should be rechecked after 6 weeks.
My advice for you in these circumstances is to talk with your brother's endocrinologist about the necessary dose adjustment of levothyroxine.
About the TG ,anti-TG as we heve discussed several times,The high level of anti-Tg makes unreliable the low level of TG.
TGab antibodies cannot be managed or controlled in any way. They rise or fall, and the only way to lower them with therapy is to suppress your immune system. Suppressing your immune system is not a good thing to do, so there is no practical treatment for those antibodies.
But i want to say the the XXXXXXX treatement will eliminate all the residual thyroid tissue and with the adequate dose of thyrogen,the situation will be under control.So,(as i said lots of times in our discussion ,don't worry because the prognosis is very good.
Hope this is helpful.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor. Thanks a lot and have a nice day , i got the report any the scan result as following : findings: the study reveals foci of increased tracer activity at thyriod bed and the rest of whole body appears unremarkable , impression : functioing thyroid remnants at thyroid bed and no evidance of distant metastasis. And the report from nuclear department shows the doasge mci 30 and near total thyriodercomy. I hope Doctor based in that explain to my the station now and the risk for him . Best regards XXXX
Brief Answer:
There is no high risk even with this results.
Detailed Answer:
Hi XXXX
The last report makes evident that there is residual thyroid tissue in the thyroid bed and this means that there are not only a couple of cells but maybe a small portion of thyroid tissue.These results show that his surgeon has done a near total and not total thyroidectomy.
Anyway this do not much change the prognosis.
The treatemet for him now is XXXXXXX Radioiodine ablation is radiation therapy in which radioactive iodine is administered to destroy or ablate residual healthy thyroid tissue remaining after thyroidectomy.
So,all the functioing thyroid remnants at thyroid bed will be destroyed and with the TSH suppressing therapy ,the situation will be under control,soon.
Hope i have answered to your questions.
If you have other doubts,feel free to ask.
Regards.
There is no high risk even with this results.
Detailed Answer:
Hi XXXX
The last report makes evident that there is residual thyroid tissue in the thyroid bed and this means that there are not only a couple of cells but maybe a small portion of thyroid tissue.These results show that his surgeon has done a near total and not total thyroidectomy.
Anyway this do not much change the prognosis.
The treatemet for him now is XXXXXXX Radioiodine ablation is radiation therapy in which radioactive iodine is administered to destroy or ablate residual healthy thyroid tissue remaining after thyroidectomy.
So,all the functioing thyroid remnants at thyroid bed will be destroyed and with the TSH suppressing therapy ,the situation will be under control,soon.
Hope i have answered to your questions.
If you have other doubts,feel free to ask.
Regards.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Hi Doctor, thanks a lot for your reply. He already took the dosage of 30 XXXXXXX 2 days ago . We meet the doctor and he sussgest tg and anti tg after 3 month and blood test and ultra sound after Sex month ( he believes after sex month tg and anti th will be there may reduced but not undecteble , do you think why?? And also he said tissue may be will gone or the tissues will be there so he will give high dosage 100 XXXXXXX or there will be mass needs surgery no talk about free disseas and ( even he mention the tissue maybe will gone , but he still anti tg which reduced so no free diesses ) so does he means control the same which you also said control and no chance of free diseases for him ? Please tell me frankly best regards XXXX
Brief Answer:
No,there is still chanse of free disease for him.
Detailed Answer:
Hi
Appologise for the late reply.
I can deduct that your brother's doctor think that 30mCu is not sufficient to to destroy or ablate residual healthy thyroid tissue remaining after thyroidectomy.
Probably,this is the reason why he think that after six months the TG and Anti -Tg level will be still detectable.
At the other side he said that your brother needs high doses of XXXXXXX and even another surgery.This facts for me are significant .because i can deduct the there is not a small portion of residual thyroid tissue.
To be XXXXXXX in these new circumstances,(when there is a considerable portion of thyroid tissue after thyroidectomy),i can say that your brother is not free of dissease and he need tight follow up.
Anyway lot of my patients with the clinical presentation like your brother in this moment,after one or 2 doses of XXXXXXX and suppressive TSH therapy ,had very good ourcomes.
This means that there are good chanses that after a high dose of XXXXXXX a second surgery(if your doctor will decide for surgery) and the right doses of TSH supressive therapy,YOur brothar can have undetectable TG , anti-Tg levels and negative WBS.
Hope this is helpful.
Regards.
No,there is still chanse of free disease for him.
Detailed Answer:
Hi
Appologise for the late reply.
I can deduct that your brother's doctor think that 30mCu is not sufficient to to destroy or ablate residual healthy thyroid tissue remaining after thyroidectomy.
Probably,this is the reason why he think that after six months the TG and Anti -Tg level will be still detectable.
At the other side he said that your brother needs high doses of XXXXXXX and even another surgery.This facts for me are significant .because i can deduct the there is not a small portion of residual thyroid tissue.
To be XXXXXXX in these new circumstances,(when there is a considerable portion of thyroid tissue after thyroidectomy),i can say that your brother is not free of dissease and he need tight follow up.
Anyway lot of my patients with the clinical presentation like your brother in this moment,after one or 2 doses of XXXXXXX and suppressive TSH therapy ,had very good ourcomes.
This means that there are good chanses that after a high dose of XXXXXXX a second surgery(if your doctor will decide for surgery) and the right doses of TSH supressive therapy,YOur brothar can have undetectable TG , anti-Tg levels and negative WBS.
Hope this is helpful.
Regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Doctor, thanks Lot for you reply , if I send the WBS scan can you decide the dosage he toke is low or now? And if it was low can he take other one now? The doctor said maybe after sex month will find mass , still tissue of no tissue. Pls advice Best regards XXXX
Brief Answer:
Ok,upload the reports.
Detailed Answer:
Hi
According to guidelines for thyroid cancer treatement,generaly,the dose for remnant ablation may range from 30 millicuries to 100 millicuries.The dose is decided to the portion of recidual elements.
Sometimes the dose is higher (100 to 200 millicuries) for people with more extensive disease. Very rarely, the dose may be larger still.
Ok,you can upload the reports of WBS and a recent neck ultrasound(with the detailed interpretation of radiologist) and we can discuss abot the dosage of XXXXXXX
Take care.
Ok,upload the reports.
Detailed Answer:
Hi
According to guidelines for thyroid cancer treatement,generaly,the dose for remnant ablation may range from 30 millicuries to 100 millicuries.The dose is decided to the portion of recidual elements.
Sometimes the dose is higher (100 to 200 millicuries) for people with more extensive disease. Very rarely, the dose may be larger still.
Ok,you can upload the reports of WBS and a recent neck ultrasound(with the detailed interpretation of radiologist) and we can discuss abot the dosage of XXXXXXX
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor, I hope you are doing well.
Thanks a lot for you reply. He did not do any ultrasound for the neck and the doctor said after six month but if you think it is important let me know what is required one and will do.
what we did is the WBS and lab test only. please find the attachments and let me know how is this remannt tissue big or small and what do you think about his case . best regards
XXXX
Desr Doctor , kindly please could you explain if my brother has also extrathyroidal extension ?? or residual toumer ???is that the same remannt tissue ?? please advise best regards
Thanks a lot for you reply. He did not do any ultrasound for the neck and the doctor said after six month but if you think it is important let me know what is required one and will do.
what we did is the WBS and lab test only. please find the attachments and let me know how is this remannt tissue big or small and what do you think about his case . best regards
XXXX
Desr Doctor , kindly please could you explain if my brother has also extrathyroidal extension ?? or residual toumer ???is that the same remannt tissue ?? please advise best regards
Brief Answer:
Yes,in my opinion,the US exam is important in your brother's case.
Detailed Answer:
Hi
I have carefully through your reports.
From the results of lab test and WBS i can say that there is recidual thyroid tissue and residual tumor.
There is not extrathyroidal extension.(this is a good think and it is very important for the prognosis.)
The WBS can not give the information how is this remannt tissue big or small.For this reason i asked to do un ultrasound because in this exam the physican can detect the dimentions, the ultrasound characteristics and if there are neck lymph nodes.
These are important element that are taken in consideration to decide for the XXXXXXX dosis.
Anyway,if your nuclear medicine physician has decided for 30 mCU,this means that this dosis is enough for the moment.Don't worry about this.
Hope i have clarified some of your doubts.
If you have other question feel free to ask.
Wish you good health.
Yes,in my opinion,the US exam is important in your brother's case.
Detailed Answer:
Hi
I have carefully through your reports.
From the results of lab test and WBS i can say that there is recidual thyroid tissue and residual tumor.
There is not extrathyroidal extension.(this is a good think and it is very important for the prognosis.)
The WBS can not give the information how is this remannt tissue big or small.For this reason i asked to do un ultrasound because in this exam the physican can detect the dimentions, the ultrasound characteristics and if there are neck lymph nodes.
These are important element that are taken in consideration to decide for the XXXXXXX dosis.
Anyway,if your nuclear medicine physician has decided for 30 mCU,this means that this dosis is enough for the moment.Don't worry about this.
Hope i have clarified some of your doubts.
If you have other question feel free to ask.
Wish you good health.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor , Hi again, from you reply it seems it is not tissue but also tumor, so from which lab test you suggest that, all or specific one??is there different value for tissue ? and does it mean the surgeon left big part from the tumor not only margin or tissue, and if there is residual tumor do we need surgery now ??? please explain.
Best regards
XXXX
Best regards
XXXX
Brief Answer:
Your bother's WBS result and Surgical pathology report.
Detailed Answer:
Hello XXXX
According to your brother's WBS result there is functioning thyroid remnants at the thyroid bed.
This means that there is recidual thyroid tissue and potentially ,residual tumor because in a multifocal thyroid carcinoma even the residual thyroid tissue can be a potential tumor foci.
Anyway this do not mean that the surgeon left big part from the tumor and not only a small part of thyroid tissue.
In my opinion, even if there is residual tumor your brother for now , do not need surgery but only radioiodine ablation.
This treatement will elimine all the residual thyroid tissue and this is enough for the moment.So,don't worry because this is the appropriate treatement for him,in this moment.
Hope i have answered to your questions.
If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you all the best.
Your bother's WBS result and Surgical pathology report.
Detailed Answer:
Hello XXXX
According to your brother's WBS result there is functioning thyroid remnants at the thyroid bed.
This means that there is recidual thyroid tissue and potentially ,residual tumor because in a multifocal thyroid carcinoma even the residual thyroid tissue can be a potential tumor foci.
Anyway this do not mean that the surgeon left big part from the tumor and not only a small part of thyroid tissue.
In my opinion, even if there is residual tumor your brother for now , do not need surgery but only radioiodine ablation.
This treatement will elimine all the residual thyroid tissue and this is enough for the moment.So,don't worry because this is the appropriate treatement for him,in this moment.
Hope i have answered to your questions.
If you do not have any clarifications, you can close the discussion and rate the answer.
Wish you all the best.
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi doctor, thanks again , so I can understand now , we can not know what is inside and we have to wait 6 month , so with ultra sound will find maybe Toumr , tissue , or maybe tissue will gone???? But now we can know from ultra sound ??? And we can not do surgery now ??? And form blood test sure there is residual toumer ? Please confirm best regards XXXX
Brief Answer:
Yes,we have to wait.
Detailed Answer:
Hi again
1.Yes,we can not know what is inside.(if the residual tissue is healthy or not)
2.After 6 month it is necessary to repeat the ultrasound,Blood test (TG and anti-TG) and the WBS . All these tests and exam will give the information if the recidive tissue "is gone".
3.For now,the ultrasound can give the information if the residual thyroid tissue is small or a big portion and the characteristics of this tissue.Anyway i suggest to talk with your brother's treating doctor if he need this exam or not.
4.As i said earlier,i don't think a second surgery is the solution, for this momment.
5.And the blood test that can give the information if there is recidual tumor are TG test and anti-TG test.
Hope i clarified all your doubts.
If you do not have other questions,please close the discussion and rate the answer.
Regards.
Yes,we have to wait.
Detailed Answer:
Hi again
1.Yes,we can not know what is inside.(if the residual tissue is healthy or not)
2.After 6 month it is necessary to repeat the ultrasound,Blood test (TG and anti-TG) and the WBS . All these tests and exam will give the information if the recidive tissue "is gone".
3.For now,the ultrasound can give the information if the residual thyroid tissue is small or a big portion and the characteristics of this tissue.Anyway i suggest to talk with your brother's treating doctor if he need this exam or not.
4.As i said earlier,i don't think a second surgery is the solution, for this momment.
5.And the blood test that can give the information if there is recidual tumor are TG test and anti-TG test.
Hope i clarified all your doubts.
If you do not have other questions,please close the discussion and rate the answer.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor, I hope you are doing well. I know it is very early but today we got the result of my brother AbTg after one month it is dropped from 74 to 44 UL is that consider a good sign ? In his case , like think if the tissue is not cancer or there is not resduial tuomer or somthing like good prognosis . Please explain and thanks in advance with best regards XXXX
Brief Answer:
Yes,it is a good sign.
Detailed Answer:
Hello XXXX.
I'm so glad to hear your good news.
Yes the AbTg that dropped after one month is a good sign.This means that the recidive tissues has disappeared and the prognosis is very good.
I have a question:Have your brother done an neck ultrasound?
Wish good health to all of you.
Best regards.
Yes,it is a good sign.
Detailed Answer:
Hello XXXX.
I'm so glad to hear your good news.
Yes the AbTg that dropped after one month is a good sign.This means that the recidive tissues has disappeared and the prognosis is very good.
I have a question:Have your brother done an neck ultrasound?
Wish good health to all of you.
Best regards.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor, thanks a lot , I just would like to let you know that the lab test reference is from 0,000 to 4,11 for you information so do you think one month could eleminate the tissue and do you think if that tissue is in it is way to gone it was not cancer and the positive margin no longer there . The treated doctor advise us to do ultra sound after 6 month , please advise best regards XXXX
Brief Answer:
The Ab Tg is still high but it is decreasing.
Detailed Answer:
Hi again XXXX
I can say that the recidive tissue can be eliminated in one month with the right dosis of XXXXXXX therapy that can ablate all the residual healthy thyroid tissue remaining after thyroidectomy.
So,in your brother's case i think that the recidive tissue"is in the way to gone" and you should discuss with the treating doctor about the possibility of a second XXXXXXX dosis.
2.Let me know about the neck ultrasound when you will have the results(this is an important investigation for the prognosis.)
Hope this is helpful.
Take care.
The Ab Tg is still high but it is decreasing.
Detailed Answer:
Hi again XXXX
I can say that the recidive tissue can be eliminated in one month with the right dosis of XXXXXXX therapy that can ablate all the residual healthy thyroid tissue remaining after thyroidectomy.
So,in your brother's case i think that the recidive tissue"is in the way to gone" and you should discuss with the treating doctor about the possibility of a second XXXXXXX dosis.
2.Let me know about the neck ultrasound when you will have the results(this is an important investigation for the prognosis.)
Hope this is helpful.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Dr. Elona,
I hope you are doing well.
Thanks a lot for your reply. So we can not rule out the positive margin nor malignancy unless will do the ultra sound ?? we have good signs but do you agree if there is decline in AbTG can we understand in his case maybe no caner , because I think , if there is cancer cells or something the AbTG would be increased and last if the next lab test the AbTg will be undetectable, what we shall consider.
Thanks aloe Dr, Elona I know maybe it very difficult to give answers when it is to early and may be you do no like to give answer for now and later it would be something change , but your opinion is very important for us. thanks again and again.
Best regerads.
XXXX
I hope you are doing well.
Thanks a lot for your reply. So we can not rule out the positive margin nor malignancy unless will do the ultra sound ?? we have good signs but do you agree if there is decline in AbTG can we understand in his case maybe no caner , because I think , if there is cancer cells or something the AbTG would be increased and last if the next lab test the AbTg will be undetectable, what we shall consider.
Thanks aloe Dr, Elona I know maybe it very difficult to give answers when it is to early and may be you do no like to give answer for now and later it would be something change , but your opinion is very important for us. thanks again and again.
Best regerads.
XXXX
Brief Answer:
Ultrasound can give the information if there is residual tissue.
Detailed Answer:
Hi again XXXX.
The ultrasound and the WBS are important post- XXXXXXX therapy investigations ,that can give the information if there is residual tissue.
Teorically after the right dosis of XXXXXXX therapy,the recidive tissue disappear and after this, the TSH supression therapy with high dosis of levothyroxine stop the recurence of tumor.
The Ab Tg can be atributted to autoimmunity process and as we discussed earlier, The Tg Antibodies has serious effects on the reliability of the Tg value.(the decline do not mean that there is no tumor)
I can say that the trend in TgAb values over time (i.e. 6 to 12 months) gives additional information on how well the tumor is responding to treatment. A trend down in TgAb levels overtime (years) is a good sign that treatment is effective.
So,if in the next lab test the AbTg will be undetectable,this means that the treatement has eliminated all the thyroid tissue and the recidive tumor.
You didn't mention if your brother take levothyroxine all the days.
Hope this information is helpful.
Take care.
Ultrasound can give the information if there is residual tissue.
Detailed Answer:
Hi again XXXX.
The ultrasound and the WBS are important post- XXXXXXX therapy investigations ,that can give the information if there is residual tissue.
Teorically after the right dosis of XXXXXXX therapy,the recidive tissue disappear and after this, the TSH supression therapy with high dosis of levothyroxine stop the recurence of tumor.
The Ab Tg can be atributted to autoimmunity process and as we discussed earlier, The Tg Antibodies has serious effects on the reliability of the Tg value.(the decline do not mean that there is no tumor)
I can say that the trend in TgAb values over time (i.e. 6 to 12 months) gives additional information on how well the tumor is responding to treatment. A trend down in TgAb levels overtime (years) is a good sign that treatment is effective.
So,if in the next lab test the AbTg will be undetectable,this means that the treatement has eliminated all the thyroid tissue and the recidive tumor.
You didn't mention if your brother take levothyroxine all the days.
Hope this information is helpful.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi Doctor, Thanks alot for you reply, yes he is getting the dosge of 150 tablet , doctor my kast question , shall we make ATPO blood test for hashimoto's dissease or no need best regards XXXX
Brief Answer:
The dose of levothyroxine is OK.
Detailed Answer:
Dear XXXX.
The TSH supression therapy is OK.
Actually,for your brother it is very important to take high dose of levothyroxine for two reasons:1.to avoid hypothyroidism and to prevent a possible recurrence of thyroid cancer.
About anti TPO test,in my opinion it is not necessary to investigate for Hashimoto thyroiditis,because your brother has done total thyroidectomy.
Hope i have clarified your doubts.
If you have other questions,feel free to ask.
Wish you all the best.
The dose of levothyroxine is OK.
Detailed Answer:
Dear XXXX.
The TSH supression therapy is OK.
Actually,for your brother it is very important to take high dose of levothyroxine for two reasons:1.to avoid hypothyroidism and to prevent a possible recurrence of thyroid cancer.
About anti TPO test,in my opinion it is not necessary to investigate for Hashimoto thyroiditis,because your brother has done total thyroidectomy.
Hope i have clarified your doubts.
If you have other questions,feel free to ask.
Wish you all the best.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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