# Radical neck dissection post TT and R-Ablation-More surgery?



## jlabrams62 (Aug 21, 2017)

My background-papillary thyroid cancer discovered by me 12/92. TT 1993 micro invasion of neck muscle and 2 ablation treatments. Recurrence discovered by US for papillary thyroid cancer 3 years ago. Had a radical neck dissection-only one cervical lymph nodes cancerous. This July, another cancerous lymph node, 8 mm, was discovered by US near the laryngeal nerve near thyroid bed. Met with endocrine who present my case to thyroid tumor board. They have recommended watchful waiting-no ablation, no surgery, no alcohol ablation, not external beam radiation. Doc increased my Synthroid to keep me in hyperthyroid state to suppress cancer growth. I feel anxious, and am not sleeping. Doctor recommended antidepressants. Anyone have success with antidepressants to help with hyperthyroid symtoms? Also, anyone else had repeat neck surgeries with a good outcome?


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## joplin1975 (Jul 21, 2011)

Did they do a stimulated thyroglobulin/TgAB test? Have they ever done that test?

What do your labs look like?

How was the nodule described in the u/s report?


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## jlabrams62 (Aug 21, 2017)

Yes, my stimulated Tg was 14 this month. Non-stimulated was 0.4 in July with negative AB. Stimulated Tg was 25 before radical neck dissection in 2014. Radioactive I-123 WBS was negative 8/2/17 and each time I have had one. Thus, the thyroid tumor board concluded that my cancer cells no longer take up iodine. TSH is currently 0.06 on Synthroid 137. Endocrine doc upped my Synthroid from 125 to 137 with a goal TSH of 0.1-0.5. She phoned today to say I should cut back by half a pill just on Sundays to get to desired level of suppression.The US with FNA report reads, "Lymph node biopsy of left inferior bed/level VII lymph node demonstrates metastatic papillary thyroid cancer." Previous surgical pathology report from 9/26/14 stated-"Right level 4 lymph node excision:metastatic papillary carcinoma on one lymph node(1 CM). Extranodal extension not identified." That lymph node was removed.


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## joplin1975 (Jul 21, 2011)

Huh.

I would want that node out, if it were me.

Regarding your symptoms, does your doctor test frees? I would imagine you could get a lower TSH without your symptoms if you lowered your synthroid and added in a little cytomel. Much more effective than adding an antidepressant.


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## jlabrams62 (Aug 21, 2017)

Thank you. I will ask my doctor about Cytomel. I do want that node out but because it is close to the laryngeal nerve the thyroid tumor board recommended not to do surgery but to save a re-do if there are more nodes. It is hard for me to do "watchful waiting," monitoring Tg and doing Ultrasounds when we know it is there. It was evident on a PET scan in 2014 at 4 mm. Now it is 8 mm. I cannot sleep and am anxious all of the time. Medically induced hyperthyroidism is affecting everything from my mood to my sleep, appetite, heart rate,etc. Regular doctor prescribed Prozac to help but it is giving my nausea, headaches,and making me more anxious. He added Lorazapam which is helping the sleep issue slightly. But, I am having a hard time with memory, focus and just feel fuzzy and clumsy. Any suggestions to help with anxiety and sleeplessness would be appreciated. Is one antidepressant that works better for those of us in an induced hyperthyroid state?


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## Lovlkn (Dec 20, 2009)

If your doc won;t run the FT-4 and FT-3 you can order yourself. Better to have that info when asking for Cytomel to suppress TSH.

I am living example of suppressed TSH due to addition of Cytomel.

Having your Free hormones in the 3/4 range will likely suppress TSH and should not have negative effects on sleep or anxious feeling. Having a high FT-4 for me personally causes the symptoms you describe. Having high FT-4 only can suppress TSH but there are other options such as adding Cytomel to increase FT-3. Usually a small dose decrease of levothyroxine is needed as having more FT-3 naturally increases FT-4 levels.

https://www.healthonelabs.com/tests_offer/buytest/220/


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## jlabrams62 (Aug 21, 2017)

Thanks. I will look into this. I have a new endocrine doc as mine retired after being my doctor for nearly twenty years. They do test frees but never seem to say anything about them. My radical neck dissection was at John Hopkins with Dr. Prescott. The new endocrine referred me to a surgeon with George Washington Hospital Center. Do you think I should get a second opinion about surgery. Surgeon said the tumor board of 15 thyroid cancer experts recommended watchful waiting.


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## joplin1975 (Jul 21, 2011)

I guess my reaction to their decision would depend on knowing if there was a point (and if there is/was, what it is) when they would recommend surgery.

I don't think watchful waiting is necessarily bad. It's just hard. What does that mean exactly? How often will they do an u/s? How often will they re-run stimulated Tg? etc etc etc

I guess if they told me this would be an annual process, I'd be more inclined to get a second opinion, but if they were talking about every 4-6 months, I might be more content to wait and watch.

I'm sorry you are in this situation. It's rather crummy...


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## jlabrams62 (Aug 21, 2017)

Yes, it is rather crummy. Thanks for your input. So, they intend to do 1-2 courses of watchful waiting:
1)Watch stimulated Tg (Repeat in 3,6 then 12 months) 
2)If Tg rises do US, brain MRI and PET scans
3)If no other evidence of disease consider removing lymph node 
4)if more disease found, refer to a clinical trial
By the way, the Free T4 was 2.1 with the TSH of 0.06 on 8/18/2017.


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## joplin1975 (Jul 21, 2011)

Ok well, that seems reasonable, given the options,

If you do get a second opinion (which I never think is a bad thing), consider trying to get in with a doctor associated with the International Thyroid Oncology Group (google ITOG).


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