Re: meds & tsh figures & thyca & normal -->

[Guest guest]

Hi ,

The following is a reply I made yesterday to someone else's question

regarding Radiation treatment(s).

The exact same answer applies concerning med. levels. Just substitute the

word meds. where you read RAI in my note to Gwynne. Essentially what I've said

is that treatment for ThyCa (Radiation tx or med. prescribing) is done

differently from place to place. Your doctors' knowledges are not in keeping

with today's standard of care with regard to thyroid cancer treatment.

(also see Dr. Ain below) this is the type of information from Dr. Ain that it

was that I was suggesting that you forward to your doctor in my previous E-Mail

to you concerning matters of treatment.

The figures for tsh level that your doctors are suggesting are numbers that

apply to people _with_ thyroids.

Two things must be considered after undergoing a tt.

1.) tsh levels _must_ be kept <0.10 for purpose of suppression of any

cancer that may

remain.

2.) The numbers for t4 _will_ be high due to # 1 and t3 will be lower than

what is

considered normal for those of whom have normally functioning

thyroids.

Nick

_________________________________________________________________________

Date: Wed, 19 Dec 2001 14:49:48 -0500

Subject: Re: RAI " causing damage " --> Gwynne

In-reply-to: <9vqieh+mq4peGroups>

Hi Gwynne,

Your question is quite complex regarding " then why is there a need to

individually

calculate doses -- why not give everyone the same dose? "

Most " first-doses " of RAI for ThyCa that are given for cases " seen and

thought to be " the 'least' troublesome in every observable regard from the

medical-technical point of view _are_

for the most part, handled as " giving the same dose to all " BUT.. the

DIFFERENCE is " PLACE " . No, not " place " as in where the cancer is ( as it really

should be..) but in " place " as to " What doctor, which hospital; which state;

what region.. who the doctor(s) studied with.. what country etc.etc. Since the

tools necessary for assessing just where, how much and what kind/type/degree of

thyca that an individual may have.. are not yet available (those such as Dr.

Ain & his research are trying to solve these issues of detection, identification

and treatment thereof) . So then. there is no " exact science " as to treatment

protocol for thyroid cancer. Don't lose heart.. because, except for a very

small percentage of persistent cases.. we seem to somehow, manage to survive.

Unless other tools for detection and assessment are found.. RAI will continue to

be the weapon of choice. The " ammunition " (RAI initial dosing standard) will

probably be increasing world wide. Dr. Ain, and others are have already

moved in this direction.

Some doctors come from schools-of-thought that adhere to a " 30 mCi first

dose " philosophy.

Others pick another number. Unless there are other observed complications that a

well-schooled ThyCa-Doctor would most usually find during the course of his

diagnostic work-up...initial treatment is mostly by-guess & by-golly because

" that's the way we do it around here " .

" As long as each single I-131

dose is within the safety margins of 200 REM marrow exposure and less than

80 mCi I-131 retained in the lung at 48 hrs (this may permit single doses

up to 650 mCi in some patients), there should be no permanent ill

consequences from necessary thyroid cancer treatment. " (Dr. Ain)

_____________________________________________________________________________

Gwynne, the following is what would be the necessary process and procedure

to determine the _maximum_ individual dose that may be administered before

causing harm outside of the intended cancerous thyca cells.

In _most_ cases (and in none that I know of: my experience being,

obviously, very limited) I doubt that Dosemitry testing is performed

pre-ablation-RAI with most " common/usual " " simple " cases of thyroid cancer

involvement.

If all thyca-treating doctors were schooled by the same instructions from

the same schools...then _most_ would apply RAI dosages, as instructed. However..

doctors that choose to think " out-side-the-box " (the Dr. Ain's) and challenge

" conventional-wisdom " (local institutional thinking) then set about " building a

better mouse-trap " . Dr. Ain pushes (cautiously) the limits of knowledge and

applies his wisdom to thinking about the results of his research and how the

information applies to better protocol of treatment and care for thyroid cancer.

Skin cancer is the most usual and thyroid, the least common of cancers. Our

disease is referred to as an " orphan " disease and receives the least amount of

support in terms of research money. This is not to say that great effort isn't

being deployed. But what it does mean..is that there isn't a concerted, focused

number working the task.

When the U.S. came to a resolve to land on the moon.. it was done. This is

called " throwing money at it " . Ain't a lot of money being devoted to thyroid

cancer research.

So we're stuck with " by gosh & by golly " for the most part. Until such time

that a critical-mass of research effort is deployed in the interest of solving

ThyCa. We have no clear choice(s) unless we come upon those and a few others..

such as Dr. Ain.

_____________________________________________________________________________

And no.. I do not agree that " ..the RAI that we don't " uptake " in thyroid

tissue must then

settle elsewhere in our body until we pass it? " This isn't what happens because

_oly thyroid-cells_ up-take IODINE to which the radiation is attached.

Relatively speaking.. RAI exists (stays) in the body for a very short period of

time. Given within known, prescribed limits.. RAI is not _known_ to cause other

damage or damage to other tissue except for salivary glands.

For your doctors to believe or have led you to believe that " damage in/to

the neck " can occur leads me to understand that they may know a lot but they

don't know enough to be treating ThyCa. Copy Dr. Ain's e-mails and bring them

with you to the meetings. Gently.. ask them to read this information concerning

ThyCa.

Sincerely,

Nick

_____________________________________________________________________________

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Date: Sat, 01 Apr 2000 23:58:02 -0500

Subject: Re: Dosemitry testing

Patty--

When I had dosimetry a couple of years ago, I had the scan dose (2 mCi

I-131) , then every day for a (5-day) week I did a 24-hour urine

collection and took it in to the hospital and they took a blood sample

and checked me with the geiger counter. They checked the urine samples

and blood samples for retention of RAI. They then calculated the maximum

allowed dose to deliver 200 RADS to the blood. They came up with two

figures, one based on whole body clearance data and the other based on

urine clearance data. I think there are two methods of doing dosimetry.

This one was called whole body dosimetry (using the method of Memorial

Sloan-Kettering Medical Center).. Interestingly enough, the actual dose

I ended up receiving was much less than either of these figures because

it was limited by the rating of the hospital's room.

Dorothy

On Sat, 1 Apr 2000 09:10:56 -0800 " Patty Byrne "

writes:

I believe the dosemitry involves testing to see

> how much

> RAI an individual can consume before it will affect the bone

> marrow...????

> Am I correct in this assessment ? Has anyone done this testing

> before, can

> you enlighten me ? Is it a once and done test or ongoing ?

>

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

At 12/19/01 05:23 PM, you wrote:

>Nick:

>

>I don't have a follow up with my new endo until Feb, so I will

>address with her then. Also, I don't have a follow up with nuc med

>doc until April, so I will address with them later too!

>

>What puzzles me about your response is that if there's no risk of

>other damage (as you said), then why is there a need to individually

>calculate doses -- why not give everyone the same dose? Do you agree

>that the RAI that we don't " uptake " in thyroid tissue must then

>settle elsewhere in our body until we pass it? This is the basis for

>the nuc med docs telling me that they didn't want to dose me to high

>and risk causing damage to other tissues in my neck.

>

>Again, I will ask more questions next time and try to gain proof if I

>can.

>

>Gwynne Bambach - Michigan

>

>

> > >,

> >

> >

> > (STUFF DELETED)

> >

> >

> > >Too much RAI can cause damage to healthy tissues in the neck area,

>so

> > >the RAI calculation is very critical in trying dose high enough;

>but

> > >not too high that it causes damage.

> > >

> > >To minimize damage from RAI, my dose was cut back to 101.5 mCi

>(and a

> > >plan for a second ablation 12 months later was discussed).

> >

> > (STUFF DELETED)

> >

> >

> >

> > >Gwynne Bambach - Michigan

> > >Pap w fol var, tumor 1.7cm, lymph node mets

> > >DX 12/21/00 (age 36)

> > >TT 1/5/01

> > >RAI 4/11/01 101.5 mCi

> > > (delayed 3 months due to iodine from previous CT scan)

> > >2nd RAI ­ upcoming 4/2002

___________________________________________________________________________

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(Dr. Ain)

Date: Tue, 08 Jun 1999 09:11:49 -0400

Subject: Correction (TSH < 0.10): Re: TSH Level Debate

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References:

>Regarding the TSH isssue:

> It is my practice and teaching to maintain TSH values in my thyroid

cancer patients to less than 0.10 mU/L. TSH is clearly a growth factor for

thyroid cancer cells, although extremely aggressive varieties grow well

independently of TSH. The most recent, well done study supports this practice

[Pujol P, Daures J-P, Nsakala N, Baldet L, Bringer J, Jaffiol C. 1996 Degree of

thyrotropin suppression as a prognostic determinant in differentiated thyroid

cancer. J Clin Endocrinol Metab. 81:4318-4323]. The reason for this is

consequent to known features of the cell biology of thyroid cancer cells as well

as clinical epidemiological evidence as above. It is easily done with careful

titration of the levothyroxine dose, good compliance by the patient, and careful

follow-up. In less than 10% of patients, a small dose of a beta-blocker, to

counteract an increased heart rate, may be useful. Recent studies have shown

that a careful TSH suppression, as described, does not significantly increase

bone loss [Marcocci C, Golia F, Bruno-Bossio G, Vignali E, Pinchera A. 1994

Carefully monitored levothyroxine suppressive therapy is not associated with

bone loss in premenopausal women. J Clin Endocrinol Metab. 78:818-823]. There is

no significant side effect when done carefully in most patients.

> This is to be considered " standard of care. " Unfortunately, the " art

of medicine " is sometimes too artful and subjective.

>**************PLEASE BE ADVISED**********************

>THE INFORMATION CONTAINED IN THIS COMMUNICATION IS INTENDED

>FOR EDUCATIONAL PURPOSES ONLY. IT IS NOT INTENDED, NOR SHOULD

>IT BE CONSTRUED, AS SPECIFIC MEDICAL ADVICE OR DIRECTIONS. ANY

>PERSON VIEWING THIS INFORMATION IS ADVISED TO CONSULT THEIR OWN

>PHYSICIAN(S) ABOUT ANY MATTER REGARDING THEIR MEDICAL CARE.

>*************************************************

> B. Ain, M.D.

>Associate Professor of Internal Medicine

>Director, Thyroid Nodule & Oncology Clinical Service

>Director, Thyroid Cancer Research Laboratory

>Division of Endocrinology and Molecular Medicine

>Department of Internal Medicine, Room MN520

>University of Kentucky Medical Center

>800 Rose Street, Lexington, Kentucky 40536-0084

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