Worried about pregnancy? (other tx protocols first) --> Sandy N.J.

[Guest guest]

(I.. like you.. am a patient) (Nick)

Hi Sandy,

" . 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. " (Dr. Ain)

(Some of your ThyCa does not retain those tsh receptors with which to

suppress thyroglobulin)

This question of yours is somewhat complex .

There are 3 major components to answer your question, though.

1.) The pregnancy, from the baby's health point of view; should be just

fine. As far as I've read.. and as long as your tsh is strictly monitored..

baby/pregnancy should be like it would have been, had you not had ThyCa

involvement.

2.) The pregnancy from _your_ health's point of view

It isn't " worse " for you to get pregnant than it would be for someone who

doesn't have a tg reading, whether suppressed or not.

3.) Aside from the pregnancy, what it is that you need to understand is,

the concept of the _degree_ of difference (differentiation) between and

among Thyroid Cancers.

Theoretically.. after having a tt.. but before RAI, a tg reading can be

expressed by production from either or both.. normal thyroid cells

remaining after surgery (didn't remove every-last-cell) or from thyroid

cancer cells. Either, they themselves not having been completely removed

together with the tissues of/with the thyroid gland removal (tt) or.. if

assuming that all normal tissue was removed, any tg then would come from

metastatic thyroid cancer cells (THyCa). (from somewhere else in the body)

Assuming that your tt was done correctly, surgically. And after having

had 3 RAI's, presuming that the failure of each/all of them to eliminate

remaining thyroid cells was not due to not having done LID, or by having

had a CT scan with iodine contrast material and/or having had the RAI's

done too close together or too soon after a CT scan with iodine contrast..

and after having neck dissections to remove metastatic tissue.. then it

must be understood that your ThyCa has become 'less-well differentiated'

(de-differentiated) This is because your cancer or much of your cancer does

not uptake iodine. Or if it does.. may be due to not retaining the RAI long

enough to be effective. Not only must there be sufficient quantity of RAI..

but it must be retained long enough to be truly effective.

Some of your cancer may no longer uptake RAI at all. But I'de want to

know about lithium use protocol, first. (have the work-up process performed

to this end)

Dr. Ain uses a protocol of diagnosis whereby he monitors for 'rapid

depletion' of RAI. And if he suspects this to be the case.. employs the use

of lithium to enhance the RAI retention factor during ablative treatment.

It may be found that your ThyCa does _not_ retain RAI long enough. In

which case, it may be the decision at that point to , not treat you at that

time because of the inherent " stunning' factor which may be a/the result

from having under gone the lithium-protocol work-up. In which case it may

be advised that you wait 6 months or more and under go RAI with lithium

protocol but __without__ having any further diagnostic administration

prior to the RAI/lithium treatment itself.

If your case were mine.. I'de be looking into this aspect _before_ any

thoughts of pregnancy.

The reason for this should be obvious, in that, if.. your ThyCa can be

resolved (treated) by lithium protocol with substantial, successful

effect.. then you'll have less to worry about regarding ThyCa growth or

rapid growth due to potential pregnancy induced tsh fluctuation.

(increase) 6 months to 1 years' time more, to wait for having a child

would be more than offset if the lithium protocol administered together

with a maximum or near maximum dosimetry-measured dose of RAI would provide

the best possibility for positive prognosis for the mother-to-be.

In other words.. your worries may be substantially reduced. And further

diagnosis and treatment may be fewer and farther in between. Just think of

the increase in both time and quality of care that you would then be able

to share with the family. _Your_ family rather than the 'family' of your

ThyCa-care personnel.

Your ThyCa, by expressing tg even when well suppressed, shows that some

of the cancer is becoming less-like normal thyroid cells.

If tg number increases when off meds. (HyPo) for testing; this shows

that _some_ ThyCa cells still express functional TSH receptors, indicating

some degree of persistent differentiation. So you have at least, 2 forms of

thyroid cancer differentiation. You may also have a third. whereby none of

this type expresses (manufactures) tg, at all.

It is interesting to note that, even though you underwent dosimetry

testing, which showed at the time, your bone marrow would safely accept a

400mCi dose of RAI , yet your physicians chose only 250 mCi ?? And this was

the 3rd of three ablative RAI's. (just shaking my head, I am)

So back to " is it worse for me to get pregnant with a detectable TG than

with someone

who doesn't? "

It isn't worse.. but if it were me.. I'de want to have weekly blood tests

to monitor my tsh so as to be able to titrate my t4 as often or as soon as

an increase of tsh is detected, if any.

The reason for this is that t4 having a 6-8 day half life, may place you

with playing catch-up if your tsh starts to rise. And since any increase in

your meds. will take _at least_ one week to act as a catch-up

performance.. any less often of tsh testing may allow your tsh to double or

more, yet. This would allow your cancer(s) (expressing tg and or any others

that express only when tsh rises) to multiply. But from the time an

increase in tsh is noted it'll be a minimum of one week before an increase

in dosage can make up for a/the deficit. So.. it could be that during a

substantial portion of your pregnancy.. your cancer(s) may grow.

It is not known whether thyroid cancer cells are suppressible by using t3

(Cytomel) But if this was possible.. could/would aid greatly someone of

your circumstance, while pregnant.

So the inherent danger of/with pregnancy isn't the focus being placed on

the baby's health/wellfare, alone.

But on _yours_ too!

This is an individual choice to be made by you and you, alone. Your doctors

do not consider your particular circumstance, a risk of pregnancy. I assume

they mean, not a risk to you. But they may have been answering your

question of pregnancy with more focus on the baby, since you did not

mention that they suggested (should have suggested) a close monitoring of

_both_, your tg AND tsh often, during your pregnancy.

I don't think you've been given every avenue to explore, relative to your

ThyCa treatment, yet.

:-)

Sincerely,

Nick

" Action is the proper fruit of knowledge "

______________________________________________________

At 11:37 PM 3/30/2003 +0000, you wrote:

>Hi ,

>

>I have the same concerns you do about pregnancy. I still have

>disease in my L neck (2 foci) and a questionable faint spot on the

>mediastinum. I've had 3 surgeries and 3 RAI's (total 500mCi)and

>still in the same position as I was a year ago. Tg same @ 23.

>My endo agreed we could go ahead knowing there are risks. He feels

>my thyca is stable enough. Good luck! Please keep us posted.

>

>Nick- thanks from me too! I was wondering,though, if the Tg level is

>as much of importance as the TSH. I guess what I want to know is it

>worse for me to get pregnant with a detectable TG than with someone

>who doesn't?

>

>Sandy in NJ

>

>