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What Do These Following Pathology Reports Indicate?
Question: Dear Doctor XXXXXXX I hope you are doing well . I provide you here with all the information regarding multi focal thyroid PTC . The surgery for the thyroid did last week and I attached all the information , and all the lump nods are ok accordance to ultra sound . I hope you can explain all the information regarding the case, treatment , cure and survivale rate . Thanks in advance and best regards XXXX
Brief Answer:
Low risk Papillary thyroid cancer
Detailed Answer:
Dear Mr. XXXX,
Good day and thank you for asking the question.. I am on a holiday and have very limited and interrupted Internet access until Monday.
Will answer the question in detail on Monday.
However, I saw the attachments. According to the pathology reports it's a PT1na, Nx, Mx. Which means the tumor is not spread outside thyroid gland and there is no evidence of lymph node or distant spread.
All the tumors were less than 1cm in size. This is a multi focal Papillary micro carcinoma which falls in LOW RISK category for recurrence according to pathology report. Please do not worry. It seems to have an excellent prognosis. Stay relaxed.
I will answer in detail regarding the further management and treatment plans as soon as I reach back my home country on Monday.. Please leave a reply.
Regards
Binu
Low risk Papillary thyroid cancer
Detailed Answer:
Dear Mr. XXXX,
Good day and thank you for asking the question.. I am on a holiday and have very limited and interrupted Internet access until Monday.
Will answer the question in detail on Monday.
However, I saw the attachments. According to the pathology reports it's a PT1na, Nx, Mx. Which means the tumor is not spread outside thyroid gland and there is no evidence of lymph node or distant spread.
All the tumors were less than 1cm in size. This is a multi focal Papillary micro carcinoma which falls in LOW RISK category for recurrence according to pathology report. Please do not worry. It seems to have an excellent prognosis. Stay relaxed.
I will answer in detail regarding the further management and treatment plans as soon as I reach back my home country on Monday.. Please leave a reply.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Doctor, Thanks alot for you reply and have a nice and safe trip . Best regards XXXX
Brief Answer:
Prognosis of low risk micro PTC
Detailed Answer:
Good morning,
Thank you.
Went through the reports again. It is a multi focal micro papillary thyroid cancer with no evidence of extrathyroidal spread. This falls in LOW RISK group for future recurrence. Many authorties do not do a post surgery, whole body iodine scan in low risk group.
However, in bilataral multi focal micro Papillary thyriid cancer, i often advice an initial whole body iodine scan along with a TSH, thyroglobulin and anti thyroglobulin antibody levels. This is typically done four to six weeks after the surgery.
Based on the scan and thyroglobulin levels, we decide on further treatment. However, as i mentioned earlier, many doctors do not do Whole body Iodine scan in Low risk papillary thyroid carcinoma. THIS IS BASED ON LOCAL POLICY OF YOUR HOSPITAL. Please discuss this with your endocrinologist. In any case, a thyroglobulin levels and Anti Thyroglobulin level( blood tests) has to be done six weeks after surgery.
I can say that, low risk micro papillary thyroid cancer has an excellent cure rate and long term prognosis. Please Stay relaxed.
Regards
Binu
Prognosis of low risk micro PTC
Detailed Answer:
Good morning,
Thank you.
Went through the reports again. It is a multi focal micro papillary thyroid cancer with no evidence of extrathyroidal spread. This falls in LOW RISK group for future recurrence. Many authorties do not do a post surgery, whole body iodine scan in low risk group.
However, in bilataral multi focal micro Papillary thyriid cancer, i often advice an initial whole body iodine scan along with a TSH, thyroglobulin and anti thyroglobulin antibody levels. This is typically done four to six weeks after the surgery.
Based on the scan and thyroglobulin levels, we decide on further treatment. However, as i mentioned earlier, many doctors do not do Whole body Iodine scan in Low risk papillary thyroid carcinoma. THIS IS BASED ON LOCAL POLICY OF YOUR HOSPITAL. Please discuss this with your endocrinologist. In any case, a thyroglobulin levels and Anti Thyroglobulin level( blood tests) has to be done six weeks after surgery.
I can say that, low risk micro papillary thyroid cancer has an excellent cure rate and long term prognosis. Please Stay relaxed.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Remy Koshy
Dear Doctor XXXXXXX i hope you are doing well. Thanks alot for your answer , Iam really appricated . Please answer the following question 1. Is it correct in some case surgey is enough and no need for idone and the cancer gone with surgery?? 2. If the ruslt of throgolbnlin comes in low level , does it mean no need for Iodine and no cancer? 3. The doctor advise me for idond with law dosage 30 and the radiology doctor or radiolgy medicane advice me for dosage of 100 idone and said if i take 30 the cure maybe up to 65% and for dosage of 100 the cure rate would be 95% and the reason because my report show caturized i hope form you doctor to explain this point in details pls pls. Thanks in advance for your help and support . Best tegards XXXX
Brief Answer:
A good complete surgery is enough in most " LOW RISK CASES"
Detailed Answer:
Hello,
To answer your questions.
**************************************************
Yes. In low risk cases, iodine treatment is not required. Your case falls in low risk category as per XXXXXXX Thyroid Association category. Some nuclear physicians decide to give empirical Iodine treatment in all cases of papillary thyroid canver without doing a scan. I do not agree with that practice especially in LOW RISK CASES ( except in selected cases). KINDLY DISUSS WITH YOUR ENDOCRIOLOGIST ABOUT IT. The dose used by most people is 30 Mci.
In any case, cure rate is excellent by a good surgery alone in low risk cases. However, if your endoccrinologist is doubtful about the surgery, he may advice Iodine treatment even in low risk cases. I do it sometimes, when i am doubtful about the completeness of surgery.
If the Thyroglobulin levels are very low 6 weeks after the surgery ( provided that Anti thyroglobulin antibody is also low), then it means no cancer in the body at that time and radio iodine is not required. You may only need to do repeat an ultrasound scan and thyroglobulin levels aftr 6 months in that case.
Kindly refer to XXXXXXX Thyroid associan's radio ioidne recommendation for low risk cases.
Best regards
Binu
A good complete surgery is enough in most " LOW RISK CASES"
Detailed Answer:
Hello,
To answer your questions.
**************************************************
Yes. In low risk cases, iodine treatment is not required. Your case falls in low risk category as per XXXXXXX Thyroid Association category. Some nuclear physicians decide to give empirical Iodine treatment in all cases of papillary thyroid canver without doing a scan. I do not agree with that practice especially in LOW RISK CASES ( except in selected cases). KINDLY DISUSS WITH YOUR ENDOCRIOLOGIST ABOUT IT. The dose used by most people is 30 Mci.
In any case, cure rate is excellent by a good surgery alone in low risk cases. However, if your endoccrinologist is doubtful about the surgery, he may advice Iodine treatment even in low risk cases. I do it sometimes, when i am doubtful about the completeness of surgery.
If the Thyroglobulin levels are very low 6 weeks after the surgery ( provided that Anti thyroglobulin antibody is also low), then it means no cancer in the body at that time and radio iodine is not required. You may only need to do repeat an ultrasound scan and thyroglobulin levels aftr 6 months in that case.
Kindly refer to XXXXXXX Thyroid associan's radio ioidne recommendation for low risk cases.
Best regards
Binu
Above answer was peer-reviewed by :
Dr. Kampana
Dear Doctor XXXXXXX thanks alot for your reply , finaly is it possiable to find a good interternational hospital in in XXXXXXX to have the rest of treatment and could you be my counsltant during this time , I will be more than happy if u accept , I hope we can arrange and we can talk by any way do you prefere, thanks in advance and best regard .
Brief Answer:
Hospital
Detailed Answer:
Hi Dear,
Thank you for your reply. I would be more than happy to help you. However, I am now working outside XXXXXXX But I can recommend a good hospital in XXXXXXX which has huge experience in dealing with thyroid cancers. XXXXXXX Institute of Medical Sciences in Kochi, XXXXXXX You may contact the endocrinology department for arranging an appointment with Endocrinologist there. They have a good team of endocrinologists, nuclear physicians, head and neck surgeons.
Regards
Binu
Hospital
Detailed Answer:
Hi Dear,
Thank you for your reply. I would be more than happy to help you. However, I am now working outside XXXXXXX But I can recommend a good hospital in XXXXXXX which has huge experience in dealing with thyroid cancers. XXXXXXX Institute of Medical Sciences in Kochi, XXXXXXX You may contact the endocrinology department for arranging an appointment with Endocrinologist there. They have a good team of endocrinologists, nuclear physicians, head and neck surgeons.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Doctor XXXXXXX I hope you are doing well. First thank you very much for all you help and support , I contacted the hospital and waiting for thier reply. Kindly please reply the following question . 1- when can I start my idine dite is it really 2 weeks , and which water can I use? Is filter tab water is ok? 2- what is the difference between multifocal and multicentric in thyroid cancer or they are same? 3- is my tumor is encapsulated ? If yes , is it really aggressive 4- what the percentage of my case to have a distance metasis ?? Thanks a lot doctor in advance and sorry for much questions , but you are really only doctor I trust in his quilfcations . Best regards
Brief Answer:
Answers
Detailed Answer:
Good morning,
thank you very much.
You should start your low iodine diet approxiately 10 days prior to the whole body iodine scan. Filter tap water is good to drink. Avoid all iodine conaining food like seaweed, sea food as well as iodine containing medicines like Povidine iodine cream/lotion etc.
Multi focal and multicentric have the same meanings. Encapsulated means, it is wrapped in a membrane. It doesnt mean it is aggressive. In fact, if the tumor is well encasulated and has not gone out of the capsule, it is a good sign.
The chances of you having distant metastasis is very low or nil as per the pathology reports. There was no evidence of any lymphnode involvement. However, we will know it more clearly after the iodine scan.
Stay calm, be positive. Please let me know the scan results.
Best wishes
Binu
Answers
Detailed Answer:
Good morning,
thank you very much.
You should start your low iodine diet approxiately 10 days prior to the whole body iodine scan. Filter tap water is good to drink. Avoid all iodine conaining food like seaweed, sea food as well as iodine containing medicines like Povidine iodine cream/lotion etc.
Multi focal and multicentric have the same meanings. Encapsulated means, it is wrapped in a membrane. It doesnt mean it is aggressive. In fact, if the tumor is well encasulated and has not gone out of the capsule, it is a good sign.
The chances of you having distant metastasis is very low or nil as per the pathology reports. There was no evidence of any lymphnode involvement. However, we will know it more clearly after the iodine scan.
Stay calm, be positive. Please let me know the scan results.
Best wishes
Binu
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hi Doctor XXXXXXX I hope your doing well. One of the international hospital in XXXXXXX inform me that , I must start with idone scan and based on that they will decied if XXXXXXX would be givin or not .so do you think it is better than start with XXXXXXX and then scan and TG test?? And will the idone scan will confirm any remaining cancer? And can also ultra sound find any cancer if any ?? My last quetion , i started my medicane levothyroxine more than 2 weekd ago , so before the scan shall i take the thyrogen injection ? and after that shall i still be in diet wating for the decision for Taking XXXXXXX or what ??? Thanks alot in advance with my best regards XXXXXXX
Brief Answer:
Answers
Detailed Answer:
Good day Mr XXXXXXX
Hope you are well.
As i mentioned earler, each place have their own protocol for follow up of thyroid cancer. In most places, they do an iodine scan first before deciding on radio iodine treatment. TG and Anti TG test should be done any way. Iodine scan will confirm if there is any cancer remaining. Most modern good resolution ultrasond machines will pick up thyroid cancer in early stage. Iodine scan can be done either by stopping levothyroxine for few weeks or by doing thyrogen injection. The hospital will decide that based on their protocol. They will also inform you clearly. Once you have a confirmed date for iodine scan, then you need to start an iodine free diet for about two weeks before the scan.
Answers
Detailed Answer:
Good day Mr XXXXXXX
Hope you are well.
As i mentioned earler, each place have their own protocol for follow up of thyroid cancer. In most places, they do an iodine scan first before deciding on radio iodine treatment. TG and Anti TG test should be done any way. Iodine scan will confirm if there is any cancer remaining. Most modern good resolution ultrasond machines will pick up thyroid cancer in early stage. Iodine scan can be done either by stopping levothyroxine for few weeks or by doing thyrogen injection. The hospital will decide that based on their protocol. They will also inform you clearly. Once you have a confirmed date for iodine scan, then you need to start an iodine free diet for about two weeks before the scan.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hi Dr. XXXXXXX
I hope this finds you well. Please explain to me the result of my lab test
As you can see The ALP Increased from 108 to 286 within one week .
and my calcium level as of today 15/3/2017 is 10.5 which is high . please note that my calcium level during after surgery was 9.2, 9 and 8.8 with reference range of 8.4 to 10.20)please explain to me frankly is it metastasis or parathyroid cancer or something else. thanks in advance and best regards
I hope this finds you well. Please explain to me the result of my lab test
As you can see The ALP Increased from 108 to 286 within one week .
and my calcium level as of today 15/3/2017 is 10.5 which is high . please note that my calcium level during after surgery was 9.2, 9 and 8.8 with reference range of 8.4 to 10.20)please explain to me frankly is it metastasis or parathyroid cancer or something else. thanks in advance and best regards
Brief Answer:
Recheck calcium in Fasting state.
Detailed Answer:
Hi,
Good morning.
Noted the lab reports. I suspect that you are taking calcium and vitamin D supplements after the surgery. If so, what dose are you taking?
Noted the alkaline phosphatase levels. It's not dangerously high. As you know, no scans so far showed any masses in neck other than the thyroid nodules. So please don't worry about parathyroid cancer. May I request you to stop all calcium supplements and recheck a serum calcium, albumin, Phosphorus and a full liver function test preferably in empty stomach.
Regards
Binu
Recheck calcium in Fasting state.
Detailed Answer:
Hi,
Good morning.
Noted the lab reports. I suspect that you are taking calcium and vitamin D supplements after the surgery. If so, what dose are you taking?
Noted the alkaline phosphatase levels. It's not dangerously high. As you know, no scans so far showed any masses in neck other than the thyroid nodules. So please don't worry about parathyroid cancer. May I request you to stop all calcium supplements and recheck a serum calcium, albumin, Phosphorus and a full liver function test preferably in empty stomach.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Kampana
Drar Dr XXXXXXX thanks alot for yoi reply , tomorrow will repeat the test again tomrrow and will send to you and to take your opnion in two treatments options . Meanwhile i would like to ask u questions could you let me know from mu pathylogy report that do i have a postive margin or free margin and what is the reflection in the treatmeant . Thanks alot and best regards from XXXX
Brief Answer:
May need to email Pathologist
Detailed Answer:
Hi
From the pathology reports, there is no mention about the margins specifically. You might need to request the pathologist to clarify. They have mentioned in the report that it is confined to the thyroid and no invasion outside the thyroid borders. If the margins are free, it indicates a good prognosis.
Regards
Binu
May need to email Pathologist
Detailed Answer:
Hi
From the pathology reports, there is no mention about the margins specifically. You might need to request the pathologist to clarify. They have mentioned in the report that it is confined to the thyroid and no invasion outside the thyroid borders. If the margins are free, it indicates a good prognosis.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Remy Koshy
Hi Dr XXXXXXX , I hope you doing well . Unfourtuntly i have a postive margin , i contact my patholgy doctor and the surgeon and i got thier reply , which i attachted to you to proivde me with clarfaction, please note that is reason that they decied XXXXXXX 30 treatment. Please advise. Best tegards XXXX
Brief Answer:
Noted the comments
Detailed Answer:
Thank you for the follow up. Noted the comment from your hospital about the tumor margins. However, it doesn't seem to be altering the prognosis in your case as the surgeon/pathologist made it clear that, the tumor type/histology was not bad. The radio iodine scan decision can be justified even though your category falls in low risk group.
We shall wait the radio iodine whole body scan reports.
Regards
Binu
Noted the comments
Detailed Answer:
Thank you for the follow up. Noted the comment from your hospital about the tumor margins. However, it doesn't seem to be altering the prognosis in your case as the surgeon/pathologist made it clear that, the tumor type/histology was not bad. The radio iodine scan decision can be justified even though your category falls in low risk group.
We shall wait the radio iodine whole body scan reports.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Kampana
Thsnkd doctor , do you the scan can change the category of risk to be high? Pleade confirm regards XXXXXXX
Brief Answer:
Baed on the report
Detailed Answer:
Scan is done to see if there is any possibility of left over thyroid tissue in neck or any spread outside thyroid. This will help us to plan further. If the scan shows spread outside the thyroid, the risk category will change. However, in your case, it is very unlikely to have spread outside the thyroid. Please stay relaxed. Mind has a big role in the treatment. Please stay relaxed.
Baed on the report
Detailed Answer:
Scan is done to see if there is any possibility of left over thyroid tissue in neck or any spread outside thyroid. This will help us to plan further. If the scan shows spread outside the thyroid, the risk category will change. However, in your case, it is very unlikely to have spread outside the thyroid. Please stay relaxed. Mind has a big role in the treatment. Please stay relaxed.
Above answer was peer-reviewed by :
Dr. Kampana
Thanks alot doctor , i will do .so dors ukyrasound could show any thing now , and does extrthyriodal means spread or tissue out side? Regards XXXXXXX
Brief Answer:
Thyroglobulin and iodine scan
Detailed Answer:
Hello,
Yes extra thyroidal means spread outside the thyroid. Since you had a recent surgery, doing another ultrasound may be difficult now. The anatomy of operated area will take a while to become normal. We shall wait for the iodine scan and Thyroglobulin reports.
Regards
Binu
Thyroglobulin and iodine scan
Detailed Answer:
Hello,
Yes extra thyroidal means spread outside the thyroid. Since you had a recent surgery, doing another ultrasound may be difficult now. The anatomy of operated area will take a while to become normal. We shall wait for the iodine scan and Thyroglobulin reports.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Remy Koshy
Dear Doctor , thanks alot for you reply. Could you answer this question do I have extrathyriodl somthing like maximal ETE that extended to trachea or not since the surgen mention the trachea was involved ?? if yes how comes the patholgy report not mentiond any invasion out side thyriod ??best regards XXXX
Brief Answer:
No tracheal invasion
Detailed Answer:
Oh no. The surgeon didn't say the trachea is involved. He only said that in one of the nodule with cancer, posterior margin was not clear. So there could be an extension. He also made it very clear that there is no tumor left behind. If there was gross extrathyroidal extension, it is easy to make out. In your case, I feel the doctors are being extra cautious which is good.
No tracheal invasion
Detailed Answer:
Oh no. The surgeon didn't say the trachea is involved. He only said that in one of the nodule with cancer, posterior margin was not clear. So there could be an extension. He also made it very clear that there is no tumor left behind. If there was gross extrathyroidal extension, it is easy to make out. In your case, I feel the doctors are being extra cautious which is good.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Doctor , thanks a lot . But it seems that you recive onley the pathologist reply , I attached the surgeon reply for trenchea , waiting for your answer for that . Regards XXXXXXX
Not able to attach , but he said , you have focal positive margin because it touched onto anterior tracheal wall and all the cancer was already remove from anterior tracheal wall. Best regards
Not able to attach , but he said , you have focal positive margin because it touched onto anterior tracheal wall and all the cancer was already remove from anterior tracheal wall. Best regards
Brief Answer:
Unable to see such a comment from surgeon
Detailed Answer:
Sorry, I could only see just one reply from your surgeon. There is no mention about trachea in that. Could you attach it again.
Unable to see such a comment from surgeon
Detailed Answer:
Sorry, I could only see just one reply from your surgeon. There is no mention about trachea in that. Could you attach it again.
Above answer was peer-reviewed by :
Dr. Prasad
Hi doctor , i was not able to attach. Here is his answe ( you have focal positive margin because it touched onto anterior tracheal wall and all the cancer was already remove from anterior tracheal wall. Best regards)
Brief Answer:
Not to worry
Detailed Answer:
Okay, what he meant was that, one of the nodules just touched the tracheal wall and since the margin of nodule capsule was not free at that surface, the surgeon is not 100% sure if there is any infiltration to trachea. The doubt is genuine. However, the surgeon is clear that, he removed the entire tumor. Please wait for thyroglobulin levels and iodine scan reports before we decide further. Thinking too much about it will not help and it will weaken your immunity. By all the probability, and by going through the surgical and pathology notes, you have a low risk tumor, the surgeon also agrees to it. PLEASE DO NOT WORRY. Have a great weekend.
Not to worry
Detailed Answer:
Okay, what he meant was that, one of the nodules just touched the tracheal wall and since the margin of nodule capsule was not free at that surface, the surgeon is not 100% sure if there is any infiltration to trachea. The doubt is genuine. However, the surgeon is clear that, he removed the entire tumor. Please wait for thyroglobulin levels and iodine scan reports before we decide further. Thinking too much about it will not help and it will weaken your immunity. By all the probability, and by going through the surgical and pathology notes, you have a low risk tumor, the surgeon also agrees to it. PLEASE DO NOT WORRY. Have a great weekend.
Above answer was peer-reviewed by :
Dr. Prasad
Dear Doctor , I hope you are doing well. I got me lab test today 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 advise me asap. Best regards XXXXXXX
Hi again , all test with hormon tablet best regards XXXXXXX
Hi again , all test with hormon tablet best regards XXXXXXX
Brief Answer:
Whole body iodine scan
Detailed Answer:
Hello,
Thanks for the message. I can see that Tg is low, but since anti Tg is high, Tg levels may not be reliable. The next step would be to do a whole body iodine scan( either after stopping Thyroxine for 4 weeks or after injecting Thyrogen, the first method is preferable). That would tell us if there is any trace of thyroid tissue in your body.
As time progress, we expect the anti Tg levels to fall and thus Tg assessment will be more reliable.
regards
Binu
Whole body iodine scan
Detailed Answer:
Hello,
Thanks for the message. I can see that Tg is low, but since anti Tg is high, Tg levels may not be reliable. The next step would be to do a whole body iodine scan( either after stopping Thyroxine for 4 weeks or after injecting Thyrogen, the first method is preferable). That would tell us if there is any trace of thyroid tissue in your body.
As time progress, we expect the anti Tg levels to fall and thus Tg assessment will be more reliable.
regards
Binu
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Doctor, thanks alot. But i can not understand what do you mean by at time progress you mention??? And frankly please is lab test show bad signs?? And is that exoect bsd prognisis ?? Plrase frankly , i want ti know. Best regards XXXXXXX
Brief Answer:
No signs of bad prognosis
Detailed Answer:
Hi,
I meant that, after few months, the Anti Tg levels will fall. Anti Tg is formed when you have thyroid tissue in body. Once it is completely removed, gradually the anti TG will fall. THERE ARE NO BAD SIGNS NOW. And as I told you earlier, so far it looks like you have very good prognosis. Now lets wait for the whole body scan. Where is it being done?
No signs of bad prognosis
Detailed Answer:
Hi,
I meant that, after few months, the Anti Tg levels will fall. Anti Tg is formed when you have thyroid tissue in body. Once it is completely removed, gradually the anti TG will fall. THERE ARE NO BAD SIGNS NOW. And as I told you earlier, so far it looks like you have very good prognosis. Now lets wait for the whole body scan. Where is it being done?
Above answer was peer-reviewed by :
Dr. Prasad
Hi Doctor, thanks for your reply . I already took 30 tablet of XXXXXXX and the scan will be on friday. I will update you . Best regards XXXXXXX
Brief Answer:
Best wishes
Detailed Answer:
Hi.
Thanks for the update. Please let me know the scan reports once reports available.
Best wishes.
Best wishes
Detailed Answer:
Hi.
Thanks for the update. Please let me know the scan reports once reports available.
Best wishes.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Doctor. Thanks a lot and have a nice day , i got the report any the dcan 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. Finaly the simulateted tsh is 68 and tg is 1,34 and anti tg is 67 drop from 74 i hope you can explain based in this information and the risk and every thing please thanks alot dr /Binu best regards XXXXXXX
Brief Answer:
Good news
Detailed Answer:
Hello,
It's a good news. The scan shows that there is no spread of cancer outside thyroid. There is only few thyroid cells in the thyroid bed which is expected. Even the anti TG is falling which is good. Strictly speaking, since you have a low risk cancer, radio iodine treatment is not required. However, as per your surgeon, since one of the thyroid cancer foci posterior margin was not free and was touching the trachea, your doctor may plan for radio iodine treatment to be on the safer side.
So in summary, don't worry. It's a good news. Cheer up. Smile. Have a lovely weekend.
Regards
Binu
Good news
Detailed Answer:
Hello,
It's a good news. The scan shows that there is no spread of cancer outside thyroid. There is only few thyroid cells in the thyroid bed which is expected. Even the anti TG is falling which is good. Strictly speaking, since you have a low risk cancer, radio iodine treatment is not required. However, as per your surgeon, since one of the thyroid cancer foci posterior margin was not free and was touching the trachea, your doctor may plan for radio iodine treatment to be on the safer side.
So in summary, don't worry. It's a good news. Cheer up. Smile. Have a lovely weekend.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Doctor XXXXXXX
I hope you are doing well.
I attached the results of my WBS, I need you opinion based in this results, it could not be only tissues and is it residual tumor and is it shown in the WBS or need to do ultra sound ? in my hospital the advise me to do after 6 month , blood test 3 month and i am really wondering of that and the doctor told me next time maybe the tissue will gone , or still there or may be will find mass ?? and he said maybe the tissue it is not cancer or not all cancer and i really wondering if not cancer how all lab test coming like that ??? please let me what do you think? XXXXXXX
I hope you are doing well.
I attached the results of my WBS, I need you opinion based in this results, it could not be only tissues and is it residual tumor and is it shown in the WBS or need to do ultra sound ? in my hospital the advise me to do after 6 month , blood test 3 month and i am really wondering of that and the doctor told me next time maybe the tissue will gone , or still there or may be will find mass ?? and he said maybe the tissue it is not cancer or not all cancer and i really wondering if not cancer how all lab test coming like that ??? please let me what do you think? XXXXXXX
Brief Answer:
No evidence of remaining cancer
Detailed Answer:
Hi.
Glad that finally the whole body iodine scan is over. There is only little thyroid tissue seen in neck which is quite common on the first scan after the surgery. After the radio iodine treatment, they couldn't find any uptake other than in the neck. This is a good sign. You don't have any thyroid cancer in your body now. Now, they will do a thyroglobulin and anti thyroglobulin Antibody, and whole body scan +/- ultrasound neck after six months. The remaining thyroid tissue in neck causes the high anti TG levels. Since it has been killed by the radio iodine treatment, there will not be any functioning thyroid tissue and anti thyroglobulin levels are excepted to fall.
You are a disease free man now. Congratulations. Stay relaxed.
Regards
Binu
No evidence of remaining cancer
Detailed Answer:
Hi.
Glad that finally the whole body iodine scan is over. There is only little thyroid tissue seen in neck which is quite common on the first scan after the surgery. After the radio iodine treatment, they couldn't find any uptake other than in the neck. This is a good sign. You don't have any thyroid cancer in your body now. Now, they will do a thyroglobulin and anti thyroglobulin Antibody, and whole body scan +/- ultrasound neck after six months. The remaining thyroid tissue in neck causes the high anti TG levels. Since it has been killed by the radio iodine treatment, there will not be any functioning thyroid tissue and anti thyroglobulin levels are excepted to fall.
You are a disease free man now. Congratulations. Stay relaxed.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi doctor, I have a feeling that you woul like to give me mode or sprit thank you . But why we have to think all the left tissu are normal not cancer , if u look to the lab test most of the rusltes are over pls explane , and is this scan enough to be sure it is only tissue or maybe resdual tomur orvwe need ultra sound ?? Best regarda XXXXXXX
Brief Answer:
According to the scan results.
Detailed Answer:
Good morning.
Sorry, I was away in Seychelles for last few days on work. Very limited Internet access. Sorry for the delay
According to the nuclear scan, there is minimal tissue in neck which is expected in thyroid bed after surgery. Please understand that, iodine scan can pickup even normal and small amount of thyroid tissue. And they have clearly stated that there is no tissue seen away from the thyroid.
Ultrasound is not required now.it can be done after six months. Believe me, as per the evidences so far, it was a multi focal, but low risk cancer. The posterior margin being not free was just a suspicion.
It's true that I am trying to counsel you and improve your mood. But at the same time, I am telling the truth according to the evidences so far. You seems to have no thyroid cancer in body now. It was a low risk disease. Please stay relaxed. No blood test was in excess. If you are talking about anti thyroid Antibody, it's common for it to be slightly high even in normal people. Once after thyroid surgery, the level will fall. We will have to repeat another thyroglobulin and anti thyroglobulin after six months. Please stay relaxed. I can see that the doctors in Bumrungrad hospital, Thailand are doing good job. I have shared the care of few of my patients from muscat with Bumrungrad hospital regarding Papillary thyroid cancer.
Stay relaxed. Have a wonderful weekend.
Regards
Binu
According to the scan results.
Detailed Answer:
Good morning.
Sorry, I was away in Seychelles for last few days on work. Very limited Internet access. Sorry for the delay
According to the nuclear scan, there is minimal tissue in neck which is expected in thyroid bed after surgery. Please understand that, iodine scan can pickup even normal and small amount of thyroid tissue. And they have clearly stated that there is no tissue seen away from the thyroid.
Ultrasound is not required now.it can be done after six months. Believe me, as per the evidences so far, it was a multi focal, but low risk cancer. The posterior margin being not free was just a suspicion.
It's true that I am trying to counsel you and improve your mood. But at the same time, I am telling the truth according to the evidences so far. You seems to have no thyroid cancer in body now. It was a low risk disease. Please stay relaxed. No blood test was in excess. If you are talking about anti thyroid Antibody, it's common for it to be slightly high even in normal people. Once after thyroid surgery, the level will fall. We will have to repeat another thyroglobulin and anti thyroglobulin after six months. Please stay relaxed. I can see that the doctors in Bumrungrad hospital, Thailand are doing good job. I have shared the care of few of my patients from muscat with Bumrungrad hospital regarding Papillary thyroid cancer.
Stay relaxed. Have a wonderful weekend.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Remy Koshy
Hi Doctor , thanks a lot for you reply and great to hear from you that you are in Oman. all the best and sure will arrange meet you soon.
Doctor do you mean if the posterior margin being not free was just a suspicion you mean all the remnant tissue is healthy. is it really true ? If yes , So where the positive margin gone with the cancerous cells? and if that also happened why, antiTG blood test is high??,,
I think high means still cancer?? Last is the WBS can show the tissue how is big??
thanjs again and again.
Best regards XXXXXXX
Doctor do you mean if the posterior margin being not free was just a suspicion you mean all the remnant tissue is healthy. is it really true ? If yes , So where the positive margin gone with the cancerous cells? and if that also happened why, antiTG blood test is high??,,
I think high means still cancer?? Last is the WBS can show the tissue how is big??
thanjs again and again.
Best regards XXXXXXX
Brief Answer:
Anti TG has long life and will disappear gradually.
Detailed Answer:
Good morning.
Noted the question. In fact as I mentioned earlier, your cancer is a low risk one. It has been completely removed. After the nuclear scan,after initial surgery, some uptake is always seen in thyroid bed. They are usually the left over small thyroid tissue which gets killed in radio iodine treatment. I am not sure of the posterior margin was damaged during surgical procedure and hence the appearance in the pathology specimen.
Anti TG is positive in many normal individuals. It's not a sign of cancer. Only that, we caht rely on thyroglobulin assay when anti TG is high. Once after complete removal of thyroid by surgery and radio iodine,, the anti TG should gradually fall. So we will have to repeat the anti TG after six months. A rise in anti TG can happen if there is residual thyroid cells or return of the cancer.
But believe me, studying your case, it is a low risk cancer.
I am on my annual vacation from today. Internet may not be available full time. However, you may ask question. I will answer when I am in WiFi range.
Regards
Binu
Anti TG has long life and will disappear gradually.
Detailed Answer:
Good morning.
Noted the question. In fact as I mentioned earlier, your cancer is a low risk one. It has been completely removed. After the nuclear scan,after initial surgery, some uptake is always seen in thyroid bed. They are usually the left over small thyroid tissue which gets killed in radio iodine treatment. I am not sure of the posterior margin was damaged during surgical procedure and hence the appearance in the pathology specimen.
Anti TG is positive in many normal individuals. It's not a sign of cancer. Only that, we caht rely on thyroglobulin assay when anti TG is high. Once after complete removal of thyroid by surgery and radio iodine,, the anti TG should gradually fall. So we will have to repeat the anti TG after six months. A rise in anti TG can happen if there is residual thyroid cells or return of the cancer.
But believe me, studying your case, it is a low risk cancer.
I am on my annual vacation from today. Internet may not be available full time. However, you may ask question. I will answer when I am in WiFi range.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Kampana
Dear doctor , have a nice and safe trip , with my best wishes, just to tell you my ab-tg today is 59 and it was 74 on 23 march , i hooe it is good news best regards and all the best
Brief Answer:
Welcome
Detailed Answer:
Thanks for your wishes, You are most welcome.
Take care.
Welcome
Detailed Answer:
Thanks for your wishes, You are most welcome.
Take care.
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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