Q: RAI effectiveness when one is WBS negative /Tg positive?

January 17, 2003

[apologies for cross-posting]

Hi all,

I am scheduled for an RAI treatment (dose 175 mci) instead of what is

supposedly (in relation to the RAI) more " tricky " surgery in March. I have

agreed to this, however am starting to wonder if the RAI will be effective?

I think would prefer surgery ....

My situation is that I am Tg positive (227, off meds) and yet have

consistently clean whole body scans (3 since TT in 1993). After a slew of

tests, the positive nodules were found near my trachea and some nerves

through US guided biopsy. My endo is not sure the RAI will work since I do

not pick up the scanning dose of radioactive iodine, BUT the theory is I

" might " take up a higher dose, thus it " might " be effective. The other

option is surgery -- but the one surgeon consulted was hesitant to do it

because of its location and suggested the RAI route first.

Has anyone been in a similar situation, (I do not have antibodies to Tg)

and has the RAI treatment worked, reduced the Tg? Or what was the basis of

your decision? I suppose the unknown is whether I am actually " resistant to

iodine " ? Should I consult with another surgeon? My endo did suggest that if

the RAI doesn't work then we could then try surgery in a year.... Am I

overreacting in being apprehensive to try the RAI -- in only wanting

radiation as a last option, not the first? Should I just do nothing and

wait to have surgery? (I know others have had more serious situations and

certainly more RAI than I, however.... Any thoughts would be appreciated.

cheers,

apprehensive in Kingston

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

papillary thyroid cancer, with mets to neck (1993)

total thyrodectomy, and right neck dissection (1993)

RAI - 100 mCi (1994), Toronto General Hospital

Negative WBS (I-131): 1994, 1996, 2002

Tg-positive ( >10 since 1993, on medication), Tg antibody negative

Tg 227 (off medication / hypo) August 2002

CT scan positive (October 2002), PET negative (November 2002)

Ultra Sound guided Biopsy - positive (December 2002)

MRI - pending

RAI - 175 mCi (scheduled March 2003)

Tg (off medication / hypo) March 2003 - pending

T4 (levothyroxine): 0.2 mg daily since 1993

TSH - on target

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