Tg Level Following Neck Dissection Surgery

I got the result of TG test, 6.3, 6 weeks post neck dissection surgery.  My End. doc said it should be below 2.  I was told that TG usually drops sharply after 2 months post surgery.  I was at 9.6 before surgery. So, I am pretty disappointed about the report.     

I was told to come back and see him after 3 months.  Is it too long?  Was my TG checked too early?  maybe if i waited longer, it would drop further?

 I had my first 150 MCi RAI back in jan/08.   When should the next RAI be?  I went to 3 places, sloan kettering, Mount sainai, Columbia.  I was told 3 different treatment plans. 

 Sloan: 1 year per RAI

Mount Sainai: 6 to 8 months

(Currently At) Columbia:  9 months

I need recommendations...

 

Thanks in advance...

When did you have your TT?  They usually consider a WBS about l year from your TT.  I actually had my TT in August of 2007.  Had a neck dissection in February 2008 and 3 months later my numbers (Tg) came down by half but it was still over 2 so I'll be getting ready for my WBS, starting my LID July 9th and going to the hospital every day the following week until completion.  They will be taking my blood on the first day and the last day.  I'll be going back to my endo one month after (hospital take 3 weeks to process Tg levels these days).  Will also be having an ultrasound of my neck.  Mid August all results should be back and will go over all the results to determine if a second treatment of RAI is in order. I guess you doctor wants to allow a total of 6 months to see if your levels continue to go down as a result of your surgery. Again, it also may have something to do when your TT was performed. 

Is a RAI ablation always needed after a neck dissection surgery?  Does anyone have similar experience where after neck surgery, tg is not down and a RAI is needed? 

 

 

Is a RAI ablation always needed after a neck dissection surgery?  Does anyone have similar experience where after neck surgery, tg is not down and a RAI is needed? 

 

 

 

On 6/28/2008 Danny2008 wrote:

Is a RAI ablation always needed after a neck dissection surgery?  Does anyone have similar experience where after neck surgery, tg is not down and a RAI is needed? 

 

 

Danny,

I beleive that you are correct that every endo will treat this differently. Dr. Ain University of Kentucky beleives that RA131 is best option when your tumor is still iodine avid. Use it. Some say too much RA131 risks salivary damageand not to abuse it. I agree with Ain. However, if you are going to do another ra131 (and you had a 150 or more dose initially) maybe wait a year to be sure you are not doing it too closely to together to risk this salivary issue.
My daugther had tt 10/07, 150 mci ra131 december 07. Six wks post ra131 has .4 tg (surpressed) and 6 months unsurpressed thyrogen hypo negative scan & US but 4.1 tg. SO we are now at 6 months and her doc says let's not do ra131 quite yet. Let's do a good US/MRI or CT of neck/lungs then revisit another ra131 in decemer (one year) to reduce possibility of salivary damage taste issues.

I was worried at first and wondered if we should just jump right in and do it at 6 months (ra131) again but then thought, not too much can happen in 6 months unless aggressive cell. She had pap/thyca no aggressive varients. She is 20 female so that is good too. Still nto great to have a tg after first treatment but it does happen. She did have mets in nodes those so that's a bit more concerining.

If you had neck dissection and one treatment, some think neck dissection (if your thyca is still iodine avid) should be followed with up second dose of ra131. I know the confusion you are dealing with. We are too with two different docs from unc and one in raleigh in disagreement on how to treat this. One says use ra131 now again unc, raleigh guy says wait til 12 motnhs to retreat.

THEN you have the nuc med/endo/ent surgeon all on one case of thyca Frankly there are just too many cooks in the kitchen and is mind numbing at times. Which cook do we trust and beleive?

Anyway, I think we need to go with our gut. AND do our homework too.

I wish you the best. Please let me know which opinion you go with. I think the 9- 12 month mark after first treatment is safe option depending on varient of thyca you are dealing with.

Good luck. DP

I had a neck dissection and if my thyroglubulin levels had been 0 with my last blood work I would not have to prepare for a follow up WBS within 2 weeks to see if a second dose of RAI is needed.  Only if your levels are still detectable.  You also have to allow a certain period of time for them to come down after neck surgery.  My neck dissection was Feb. 5 and my 3 month follow up blood work still indicated a dectectable amount although my numbers came down some.  I have to have the LID and will have thyrogen injections this time around.  Blood work will be done on the first day and the last day (5 days later).  I will also be having another ultrasound of the neck and thyroid region.  I go back mid August and my understanding is that based on the blood levels at that time and my scan and ultrasound results a second course of RAI may or may not be indicated.  I know all this is confusing and different doctors do have different opinions on the timing and course of things.  Hope this info helps!

I wish my thyroglobulin level would be undetectable, too!  I have "tall cell' papillary and my TG level won't drop.  I had RAI 150 and follow-up tracer dose 6 months later.   WBS and PET scans seem clear, yet my blood levels are not good.  I can't seem to get any answers from the doctor.  What could this mean?  Thanks, Tara

I have tall cell as well.  My understanding is that the RAI ablation may or may not work against tall cell.  The positive nodes in my neck were tall cell and they did not respond to RAI ablation.  Due to this my endo originally indicated I would have to be followed with ultrasound of the neck and monitoring my blood levels which would be a better indicator of something going on.  Since my thyroglobulin levels have not come down completely I'll be starting my LID actually Wednesday of this week to prepare for scanning.  Again, depending on this, my ultrasound and blood work it will determine whether I'll have a second ablation treatment.  He said even if the original treatment did not address all the tall cell, they at least would try a second time if it were indicated.  If my tests indicate a presence and the RAI does not address it I don't know what other options are used.  I know if they determined it to be in the neck, surgery would be indicated.  I had 28 nodes removed from the affected side and 3 small cancerous nodes were found but I have read where some indicate that the lymph nodes of the neck should be removed from both sides as prevention for recurrence.  I've never had a PET, I would think this would be pretty indicative of any spread so a negative test is good.  Again, the blood level that relates to recurrence would be the thyroglobulin not the T3 etc.