(suppressed) 0 tg and recurrence??? is it possible?

[Guest guest]

Hi everyone,

I have a question. I know that a suppressed tg value is not as

reliable or accurate as a hypo tg value. My question is has anyone

experienced a 0 tg while suppressed and still end up having thyca at

scan time OR has anyone had a 0 tg while suppressed to see it

suddnely rise while hypo, indicating a possible reccurrence?

Thanks, just wondering beacuse my last tg taken was about 3-4 months

after my initial RAI was 0 (suppressed). I do realize it has been

several months since my last tg (I wonder what it would have been

before I went off my synth...) and that anything can happen in just a

few months. I am the one who has been complaining about " knowing " I

have a reccurence going on and neck symptoms.

Thanks again,

Michele

28 from CT

in hypo-hell scan on 6/15

[Guest guest]

> .... has anyone

> experienced a 0 tg while suppressed and still end up having thyca at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

Hi, Michele -

I don't know about having a 0 tg while suppressed, and then showing an elevation

while hypo, but I do know that several people have had " undetectable " tg levels

while suppressed, and then

unfortunately turned out to have a very elevated tg level once off meds.

That's why it's so important for us to always have periodic hypo tg tests - for

the rest of our lives.

In my humble, layperson's opinion, I think that THAT is an excellent use for

Thyrogen. When a scan isn't deemed necessary, raising the TSH artificially for

a blood test seems like a practical

thing to do.

Below is a letter from Dr. Ain on the subject, which I offer only as a matter

of information, in the hope that it will be relevant and of interest to you.

- katie

===========================================

Subject: Re: Scan negative thyroglobulin elevations

Date: Fri, 7 Jul 2000 23:44:40 -0500

Reply-To: thyca@...

> Dr. Ain, Do you see it very often where someone is <3 for years and then goes

> up to 28 when hypo? Would that indicate there is a lot, that it is fast, or

> just that it has been suppressed? thank you again .....

Dear ThyCa Members .... :

It is not a rare event to see patients whose thyroglobulin values had

been undetectable, while their TSH was suppressed on levothyroxine

therapy, for many years and whose hypothyroid thyroglobulin values

(when the TSH is >30) is markedly elevated. Sometimes one sees

thyroglobulin elevations above 100 ng/mL. This suggests several

points, some which are definite and some which are reasonable

conjectures:

1. We are very sure that this represents residual or metastatic

thyroid carcinoma.

2. The ability to completely suppress the thyroglobulin with

suppression of TSH implies that the cancer cells express functional

TSH receptors, indicating some degree of persistent differentiation.

3. Without any comparable hypothyroid thyroglobulin value for 9

years, it is impossible to imply a growth or recurrence rate.

4. In my experience, papillary cancers without previous known

distant metastases, presenting in this current fashion, are usually

able to be found in the neck (most effectively by extensive

ultrasound evaluation with fine needle biopsy confirmation). It is

important to precede such evaluation with an I-131 treatment of at

least 150 mCi and a post-therapy whole body scan (2 days after the

treatment dose) to see if tumor can be localized. It is also

important to rule out non-radioactive iodine contamination by

following a low iodine diet and measuring the iodine excretion in a

24-hour urine sample, making sure that the scan was not made negative

by stable iodine contamination, prior to administering the I-131

therapy dose.

**************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 MN524

University of Kentucky Medical Center

800 Rose Street, Lexington, Kentucky 40536-0298

========================================================

[Guest guest]

> .... has anyone

> experienced a 0 tg while suppressed and still end up having thyca at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

Hi, Michele -

I don't know about having a 0 tg while suppressed, and then showing an elevation

while hypo, but I do know that several people have had " undetectable " tg levels

while suppressed, and then

unfortunately turned out to have a very elevated tg level once off meds.

That's why it's so important for us to always have periodic hypo tg tests - for

the rest of our lives.

In my humble, layperson's opinion, I think that THAT is an excellent use for

Thyrogen. When a scan isn't deemed necessary, raising the TSH artificially for

a blood test seems like a practical

thing to do.

Below is a letter from Dr. Ain on the subject, which I offer only as a matter

of information, in the hope that it will be relevant and of interest to you.

- katie

===========================================

Subject: Re: Scan negative thyroglobulin elevations

Date: Fri, 7 Jul 2000 23:44:40 -0500

Reply-To: thyca@...

> Dr. Ain, Do you see it very often where someone is <3 for years and then goes

> up to 28 when hypo? Would that indicate there is a lot, that it is fast, or

> just that it has been suppressed? thank you again .....

Dear ThyCa Members .... :

It is not a rare event to see patients whose thyroglobulin values had

been undetectable, while their TSH was suppressed on levothyroxine

therapy, for many years and whose hypothyroid thyroglobulin values

(when the TSH is >30) is markedly elevated. Sometimes one sees

thyroglobulin elevations above 100 ng/mL. This suggests several

points, some which are definite and some which are reasonable

conjectures:

1. We are very sure that this represents residual or metastatic

thyroid carcinoma.

2. The ability to completely suppress the thyroglobulin with

suppression of TSH implies that the cancer cells express functional

TSH receptors, indicating some degree of persistent differentiation.

3. Without any comparable hypothyroid thyroglobulin value for 9

years, it is impossible to imply a growth or recurrence rate.

4. In my experience, papillary cancers without previous known

distant metastases, presenting in this current fashion, are usually

able to be found in the neck (most effectively by extensive

ultrasound evaluation with fine needle biopsy confirmation). It is

important to precede such evaluation with an I-131 treatment of at

least 150 mCi and a post-therapy whole body scan (2 days after the

treatment dose) to see if tumor can be localized. It is also

important to rule out non-radioactive iodine contamination by

following a low iodine diet and measuring the iodine excretion in a

24-hour urine sample, making sure that the scan was not made negative

by stable iodine contamination, prior to administering the I-131

therapy dose.

**************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 MN524

University of Kentucky Medical Center

800 Rose Street, Lexington, Kentucky 40536-0298

========================================================

[Guest guest]

> .... has anyone

> experienced a 0 tg while suppressed and still end up having thyca at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

Hi, Michele -

I don't know about having a 0 tg while suppressed, and then showing an elevation

while hypo, but I do know that several people have had " undetectable " tg levels

while suppressed, and then

unfortunately turned out to have a very elevated tg level once off meds.

That's why it's so important for us to always have periodic hypo tg tests - for

the rest of our lives.

In my humble, layperson's opinion, I think that THAT is an excellent use for

Thyrogen. When a scan isn't deemed necessary, raising the TSH artificially for

a blood test seems like a practical

thing to do.

Below is a letter from Dr. Ain on the subject, which I offer only as a matter

of information, in the hope that it will be relevant and of interest to you.

- katie

===========================================

Subject: Re: Scan negative thyroglobulin elevations

Date: Fri, 7 Jul 2000 23:44:40 -0500

Reply-To: thyca@...

> Dr. Ain, Do you see it very often where someone is <3 for years and then goes

> up to 28 when hypo? Would that indicate there is a lot, that it is fast, or

> just that it has been suppressed? thank you again .....

Dear ThyCa Members .... :

It is not a rare event to see patients whose thyroglobulin values had

been undetectable, while their TSH was suppressed on levothyroxine

therapy, for many years and whose hypothyroid thyroglobulin values

(when the TSH is >30) is markedly elevated. Sometimes one sees

thyroglobulin elevations above 100 ng/mL. This suggests several

points, some which are definite and some which are reasonable

conjectures:

1. We are very sure that this represents residual or metastatic

thyroid carcinoma.

2. The ability to completely suppress the thyroglobulin with

suppression of TSH implies that the cancer cells express functional

TSH receptors, indicating some degree of persistent differentiation.

3. Without any comparable hypothyroid thyroglobulin value for 9

years, it is impossible to imply a growth or recurrence rate.

4. In my experience, papillary cancers without previous known

distant metastases, presenting in this current fashion, are usually

able to be found in the neck (most effectively by extensive

ultrasound evaluation with fine needle biopsy confirmation). It is

important to precede such evaluation with an I-131 treatment of at

least 150 mCi and a post-therapy whole body scan (2 days after the

treatment dose) to see if tumor can be localized. It is also

important to rule out non-radioactive iodine contamination by

following a low iodine diet and measuring the iodine excretion in a

24-hour urine sample, making sure that the scan was not made negative

by stable iodine contamination, prior to administering the I-131

therapy dose.

**************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 MN524

University of Kentucky Medical Center

800 Rose Street, Lexington, Kentucky 40536-0298

========================================================

[Guest guest]

--

> My question is has anyone

> experienced a 0 tg while suppressed and still end up having thyca at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

Dr. Ain's posts on this are below.

Nina

geiger@...

--It is not a rare event to see patients whose thyroglobulin values had been

undetectable, while their TSH was suppressed on levothyroxine therapy, for

many years and whose hypothyroid thyroglobulin values

(when the TSH is >30) is markedly elevated. Sometimes one sees thyroglobulin

elevations above 100 ng/mL. This suggests several points, some which are

definite and some which are reasonable conjectures:

*We are very sure that this represents residual or metastatic thyroid

carcinoma.

* The ability to completely suppress the thyroglobulin with suppression of

TSH implies that the cancer cells express functional TSH receptors,

indicating some degree of persistent differentiation.

* In my experience, papillary cancers without previous known distant

metastases, presenting in this current fashion, are usually able to be found

in the neck (most effectively by extensive ultrasound evaluation with fine

needle biopsy confirmation). It is important to precede such evaluation with

an I-131 treatment of at least 150 mCi and a post-therapy whole body scan (2

days after the treatment dose) to see if tumor can be localized. It is also

important to rule out non-radioactive iodine contamination by following a

low iodine diet and measuring the iodine excretion in a 24-hour urine

sample, making sure that the scan was not made negative by stable iodine

contamination, prior to administering the I-131 therapy dose.--Dr. Ain thyca

7-00

--The thyroglobulin serves as a tumor marker for the presence of

differentiated thyroid carcinoma, only in the context of previous total

thyroidectomy and radioiodine ablation therapy. This protein is a product of

the thyroid cancer cell. When the cell is stimulated by high levels of TSH

(when hypothyroid) it may produce more thyroglobulin. When the cell is not

exposed to TSH (when on levothyroxine therapy) it often produces little or

no thyroglobulin. For this reason, any thyroglobulin which is measurable

when taking levothyroxine (usually above 2-3 ng/mL) is significant for

persistent or recurrent cancer. When taking levothyroxine, there may be

thyroid cancer cells present, but the low TSH levels do not permit them to

release much thyroglobulin. On the other hand, when hypothyroid (TSH levels

greater than 30), these cells are more likely to release enough

thyroglobulin to be measured in the blood (usually greater than 5 ng/mL). In

theory, patients with complete absence of thyroid cancer cells should have

undetectable thyroglobulin levels (less than or equal to 1.0), both while

hypothyroid and while on thyroid hormone. Thus, thyroglobulin assessments

are more sensitive when hypothyroid, but meaningful if elevated whether on

or off thyroid hormone. Thyroglobulin is an independent marker for the

presence of residual thyroid cancer. Sometimes, the I-131 whole body scan is

negative although the thyroglobulin level is elevated (above 5-8 ng/mL). In

this situation, the patient has residual thyroid cancer, even though it is

not evident on the scan. Frequently, such a person may have a positive

response to I-131 therapy (> 150 mCi dose) with a positive post-therapy scan

and decreased follow-up thyroglobulin levels. Sometimes such a patient does

not have a

response to radioiodine, indicating dedifferentiated tumor that no longer

takes up iodine. This type of patient is one of the topics of research in

our laboratory since new and different approaches are likely to be

needed. -- B. Ain, M.D.

[Guest guest]

--

> My question is has anyone

> experienced a 0 tg while suppressed and still end up having thyca at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

Dr. Ain's posts on this are below.

Nina

geiger@...

--It is not a rare event to see patients whose thyroglobulin values had been

undetectable, while their TSH was suppressed on levothyroxine therapy, for

many years and whose hypothyroid thyroglobulin values

(when the TSH is >30) is markedly elevated. Sometimes one sees thyroglobulin

elevations above 100 ng/mL. This suggests several points, some which are

definite and some which are reasonable conjectures:

*We are very sure that this represents residual or metastatic thyroid

carcinoma.

* The ability to completely suppress the thyroglobulin with suppression of

TSH implies that the cancer cells express functional TSH receptors,

indicating some degree of persistent differentiation.

* In my experience, papillary cancers without previous known distant

metastases, presenting in this current fashion, are usually able to be found

in the neck (most effectively by extensive ultrasound evaluation with fine

needle biopsy confirmation). It is important to precede such evaluation with

an I-131 treatment of at least 150 mCi and a post-therapy whole body scan (2

days after the treatment dose) to see if tumor can be localized. It is also

important to rule out non-radioactive iodine contamination by following a

low iodine diet and measuring the iodine excretion in a 24-hour urine

sample, making sure that the scan was not made negative by stable iodine

contamination, prior to administering the I-131 therapy dose.--Dr. Ain thyca

7-00

--The thyroglobulin serves as a tumor marker for the presence of

differentiated thyroid carcinoma, only in the context of previous total

thyroidectomy and radioiodine ablation therapy. This protein is a product of

the thyroid cancer cell. When the cell is stimulated by high levels of TSH

(when hypothyroid) it may produce more thyroglobulin. When the cell is not

exposed to TSH (when on levothyroxine therapy) it often produces little or

no thyroglobulin. For this reason, any thyroglobulin which is measurable

when taking levothyroxine (usually above 2-3 ng/mL) is significant for

persistent or recurrent cancer. When taking levothyroxine, there may be

thyroid cancer cells present, but the low TSH levels do not permit them to

release much thyroglobulin. On the other hand, when hypothyroid (TSH levels

greater than 30), these cells are more likely to release enough

thyroglobulin to be measured in the blood (usually greater than 5 ng/mL). In

theory, patients with complete absence of thyroid cancer cells should have

undetectable thyroglobulin levels (less than or equal to 1.0), both while

hypothyroid and while on thyroid hormone. Thus, thyroglobulin assessments

are more sensitive when hypothyroid, but meaningful if elevated whether on

or off thyroid hormone. Thyroglobulin is an independent marker for the

presence of residual thyroid cancer. Sometimes, the I-131 whole body scan is

negative although the thyroglobulin level is elevated (above 5-8 ng/mL). In

this situation, the patient has residual thyroid cancer, even though it is

not evident on the scan. Frequently, such a person may have a positive

response to I-131 therapy (> 150 mCi dose) with a positive post-therapy scan

and decreased follow-up thyroglobulin levels. Sometimes such a patient does

not have a

response to radioiodine, indicating dedifferentiated tumor that no longer

takes up iodine. This type of patient is one of the topics of research in

our laboratory since new and different approaches are likely to be

needed. -- B. Ain, M.D.

[Guest guest]

--

> My question is has anyone

> experienced a 0 tg while suppressed and still end up having thyca at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

Dr. Ain's posts on this are below.

Nina

geiger@...

--It is not a rare event to see patients whose thyroglobulin values had been

undetectable, while their TSH was suppressed on levothyroxine therapy, for

many years and whose hypothyroid thyroglobulin values

(when the TSH is >30) is markedly elevated. Sometimes one sees thyroglobulin

elevations above 100 ng/mL. This suggests several points, some which are

definite and some which are reasonable conjectures:

*We are very sure that this represents residual or metastatic thyroid

carcinoma.

* The ability to completely suppress the thyroglobulin with suppression of

TSH implies that the cancer cells express functional TSH receptors,

indicating some degree of persistent differentiation.

* In my experience, papillary cancers without previous known distant

metastases, presenting in this current fashion, are usually able to be found

in the neck (most effectively by extensive ultrasound evaluation with fine

needle biopsy confirmation). It is important to precede such evaluation with

an I-131 treatment of at least 150 mCi and a post-therapy whole body scan (2

days after the treatment dose) to see if tumor can be localized. It is also

important to rule out non-radioactive iodine contamination by following a

low iodine diet and measuring the iodine excretion in a 24-hour urine

sample, making sure that the scan was not made negative by stable iodine

contamination, prior to administering the I-131 therapy dose.--Dr. Ain thyca

7-00

--The thyroglobulin serves as a tumor marker for the presence of

differentiated thyroid carcinoma, only in the context of previous total

thyroidectomy and radioiodine ablation therapy. This protein is a product of

the thyroid cancer cell. When the cell is stimulated by high levels of TSH

(when hypothyroid) it may produce more thyroglobulin. When the cell is not

exposed to TSH (when on levothyroxine therapy) it often produces little or

no thyroglobulin. For this reason, any thyroglobulin which is measurable

when taking levothyroxine (usually above 2-3 ng/mL) is significant for

persistent or recurrent cancer. When taking levothyroxine, there may be

thyroid cancer cells present, but the low TSH levels do not permit them to

release much thyroglobulin. On the other hand, when hypothyroid (TSH levels

greater than 30), these cells are more likely to release enough

thyroglobulin to be measured in the blood (usually greater than 5 ng/mL). In

theory, patients with complete absence of thyroid cancer cells should have

undetectable thyroglobulin levels (less than or equal to 1.0), both while

hypothyroid and while on thyroid hormone. Thus, thyroglobulin assessments

are more sensitive when hypothyroid, but meaningful if elevated whether on

or off thyroid hormone. Thyroglobulin is an independent marker for the

presence of residual thyroid cancer. Sometimes, the I-131 whole body scan is

negative although the thyroglobulin level is elevated (above 5-8 ng/mL). In

this situation, the patient has residual thyroid cancer, even though it is

not evident on the scan. Frequently, such a person may have a positive

response to I-131 therapy (> 150 mCi dose) with a positive post-therapy scan

and decreased follow-up thyroglobulin levels. Sometimes such a patient does

not have a

response to radioiodine, indicating dedifferentiated tumor that no longer

takes up iodine. This type of patient is one of the topics of research in

our laboratory since new and different approaches are likely to be

needed. -- B. Ain, M.D.

[Guest guest]

, Yes you can have a recurrance if your Tg is undetectable

when suppressed. My Tg was undectable when suppressed. When I went

off my meds and had it tested, it rose to 88. ( This is when I found

out I had a recurrance last summer) Also, my scan was clean. So I

think you need both to get a good picture of what is going on! ( that

is a Tg while hypo and a scan!) Bekki in TX; tt & rai'89; rai 7/00;

mid-neck dissection 2/01; 5/01 finished EBR

> Hi everyone,

>

> I have a question. I know that a suppressed tg value is not as

> reliable or accurate as a hypo tg value. My question is has anyone

> experienced a 0 tg while suppressed and still end up having thyca

at

> scan time OR has anyone had a 0 tg while suppressed to see it

> suddnely rise while hypo, indicating a possible reccurrence?

>

> Thanks, just wondering beacuse my last tg taken was about 3-4

months

> after my initial RAI was 0 (suppressed). I do realize it has been

> several months since my last tg (I wonder what it would have been

> before I went off my synth...) and that anything can happen in just

a

> few months. I am the one who has been complaining about " knowing " I

> have a reccurence going on and neck symptoms.

>

> Thanks again,

>

> Michele

> 28 from CT

>

> in hypo-hell scan on 6/15