No Rai Tracer Dose Normal?

I had a TT on 5/21/08 due to a 2.2cm papillary tumor. The pathology report confirmed the biopsy result (pap. ca.) with the only negative surprise being some microscopic extrathyroidal extension of the tumor (i.e. some cancer cells were found on the outside of the thyroid). There did not appear to be any lymph node involvement, and the one they took out was negative for cancer. Both my surgeon and endo have recommended a 100 mCi dose of RAI for remnant ablation due to i) the tumor being > 1.5cm and/or ii) the extrathyroidal extension (according to them, either one of these factors would warrant RAI). My endo is comfortable using Thyrogen for the remnant ablation dose, and I am cool with that.

My question is this: as I understand it, they are not going to do a WBS to see if the disease is metastatic prior to the ablation dose. Instead, they will do a WBS after the ablation dose to see if it has spread anywhere else. Based on my research, this presents 2 potential issues: 1) how do they know what the proper dose of RAI is if no one knows if it has spread and 2) how do they know using Thyrogen is a good idea if it is only indicated for non-metastatic disease?

Has anyone else had Thyrogen-assisted RAI for remnant ablation following surgery without a diagnostic tracer dose and WBS first? Thanks in advance.

Tim 

Hi

 I can't speak to the thyrogen but as far as no tracer dose is concerned, my husband didn't have that either. They just sent him off for 150 RAI. (turned out the final dosage was 160). The reason being he had some minor extrathyroidal extension as well. Also, 2 of the 4 nodes removed were positive for PTC. I think they just know the RAI will have to be a fairly large dose without using a tracer if certain factors are present like yours and my husband's. He then had his WBS a week after treatment. Good luck.

 Karen

On 6/6/2008 tim214 wrote:

I had a TT on 5/21/08 due to a 2.2cm papillary tumor. The pathology report confirmed the biopsy result (pap. ca.) with the only negative surprise being some microscopic extrathyroidal extension of the tumor (i.e. some cancer cells were found on the outside of the thyroid). There did not appear to be any lymph node involvement, and the one they took out was negative for cancer. Both my surgeon and endo have recommended a 100 mCi dose of RAI for remnant ablation due to i) the tumor being > 1.5cm and/or ii) the extrathyroidal extension (according to them, either one of these factors would warrant RAI). My endo is comfortable using Thyrogen for the remnant ablation dose, and I am cool with that.

My question is this: as I understand it, they are not going to do a WBS to see if the disease is metastatic prior to the ablation dose. Instead, they will do a WBS after the ablation dose to see if it has spread anywhere else. Based on my research, this presents 2 potential issues: 1) how do they know what the proper dose of RAI is if no one knows if it has spread and 2) how do they know using Thyrogen is a good idea if it is only indicated for non-metastatic disease?

Has anyone else had Thyrogen-assisted RAI for remnant ablation following surgery without a diagnostic tracer dose and WBS first? Thanks in advance.

Tim 

I just finished treatment a couple of days ago.  I had a 1.4 cm tumor with cancer in the one lymph node that was removed.  I also did not have a tracer dose before hand.  I had 125 mCi and then a WBS 6 days later which showed all the uptake just in the thyroid area.  I too was a bit concerned that they didn't do the scan prior to the ablation, but I guess once it has moved out of the thyroid, the dose they give you is meant to kill the remaining tissue in the area and anywhere else it might be.  My ablation was Thyrogen assisted. 

On 6/6/2008 tim214 wrote:

I had a TT on 5/21/08 due to a 2.2cm papillary tumor. The pathology report confirmed the biopsy result (pap. ca.) with the only negative surprise being some microscopic extrathyroidal extension of the tumor (i.e. some cancer cells were found on the outside of the thyroid). There did not appear to be any lymph node involvement, and the one they took out was negative for cancer. Both my surgeon and endo have recommended a 100 mCi dose of RAI for remnant ablation due to i) the tumor being > 1.5cm and/or ii) the extrathyroidal extension (according to them, either one of these factors would warrant RAI). My endo is comfortable using Thyrogen for the remnant ablation dose, and I am cool with that.

My question is this: as I understand it, they are not going to do a WBS to see if the disease is metastatic prior to the ablation dose. Instead, they will do a WBS after the ablation dose to see if it has spread anywhere else. Based on my research, this presents 2 potential issues: 1) how do they know what the proper dose of RAI is if no one knows if it has spread and 2) how do they know using Thyrogen is a good idea if it is only indicated for non-metastatic disease?

Has anyone else had Thyrogen-assisted RAI for remnant ablation following surgery without a diagnostic tracer dose and WBS first? Thanks in advance.

Tim 

I had a 2.4cm follicular nodule.  They found two cancerous lymph nodes but the surgeon checked out the rest of my lymph nodes and neck area and believed it all looked good.  A surgeon can usually detect if it has metastasized.  Your neck would be pretty bad; usually.  I did not have tracer; only 100mc of RAI.  I used Thyrogen and am a huge proponent of it.  Hypo hell is really old school and should only be used if it has metastasized outside of the neck area.  I believe, from what I've studied that soon that won't matter either.

Your course is very normal.