# Lab Results !!!



## ScaredAJ (Jun 3, 2011)

So I have them! I'll post what they say. Lots of notes so Here I go! 
I am overly excited, finally light at the end of my tunnel!

Free T4 ( .6-1.6)
.6

TSH 3rd Gen- (.34-3.0)
6.39 <--OUCH!
increase Levo to 150 Mcg

Free T3 (2.5-3.9)
2.6

Total T3 (.9-1.8)
.8

Anti-Nuclear AB (0-99)
39- Athena ana interpretation 
<100-Neg
100-200 =Eguivocal
>120 Positive

Anti TPO (<35) 
>1000

Anti Thyoglob AB (<20)
<20

TSI (<140)

94-INFCE Results units % baseline TSI results greater than or equal to (>=) 140% of the reference control are considered positive

TBI -(none)
4352 (B)

(B) TBG 28.6 (13.5-30.9
to convert to nmol/l multiply result by 18.5

So opinions?


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## Andros (Aug 26, 2009)

ScaredAJ said:


> So I have them! I'll post what they say. Lots of notes so Here I go!
> I am overly excited, finally light at the end of my tunnel!
> 
> Free T4 ( .6-1.6)
> ...


Well; according to the TSH, T3 and FT3, you are in dire need of thryoxine replacement. What dose were you on prior to being increased to 150 mcg of Levothyroxine?

Also, you do have antibody activity and this has to be sorted. ANA is "suggestive" of a myriad of things.
http://www.labtestsonline.org/understanding/analytes/ana/test.html

TPO is really high which again is "suggestive" of a myriad of things.

TPO
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

You do have TSI which does make me think that you are headed to hyperthyroid but the blocking and binding antibodies are at work here keeping it down.

TSI
Normally, there is **** no**** TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.

http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html


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(B) TBG 28.6 (13.5-30.9
to convert to nmol/l multiply result by 18.5
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And is the above a typo? Is that TGB?
copy and paste
In the situations described above, TBG testing is not very useful. However, if total thyroid hormone levels point to hypothyroidism or hyperthyroidism in the absence of accompanying symptoms, the utility of TBG testing becomes more evident, since TBG production can be modified by other factors such as estrogen levels, corticosteroid levels, or liver failure. If, for example, the TBG level is high, which can occur when estrogen levels are high, the TBG will bind more thyroid hormone, decreasing the free hormone available in the blood, which leads to stimulation of TSH, and the production of more thyroid hormone. In this case, the total thyroid hormone level will be high. However, when labeled hormone is added, since TBG is so high, it will bind to the TBG, leaving little free labeled hormone for uptake into the resin. 
http://en.wikipedia.org/wiki/Thyroxine-binding_globulin

And is the other TBII? If so, I don't quite understand the results.

By reading the above about TBG, do you see what I mean about these things altering the numbers (blocking and binding globulin?) But first I have to know it that is TBG and if that was a typo.

I know you are thrilled to get these labs and I am also. I hope others can comment because I sure don't know everything there is to know about all this stuff. We need all the help we can get here.


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## ScaredAJ (Jun 3, 2011)

Ok, it says 
TBI 4352 (B)-to see note B

note B says TBG 28.6 13.5-30.9 mcg/ml
then about the conversion. Does that help?

I was at 137 mcg for 6 weeks before I was increased to 150.

Would the ANA mean Hashi? I have other results here too sonograms FNA CT scan. just a fast recap I have hurtle cells, and the pathologist thinks I have Hashi's, but wanted to correlated with other findings, so would the ANA just confirm that?

I am worried about the liver function test, but only because I have seen the numbers, and the hover on low. I think I may need to have that looked into a bit further, but its probably nothing.


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## ScaredAJ (Jun 3, 2011)

I don't have hyperthyroidism? I am Hypothyroid? and have been on Levo for 6 years? I can say this blood was drawn at around 3 pm instead of the morning hours.

The afternoon/evenings are when my fatigue is at its worst. That may explain the high TSH? Maybe?

I don't know what to think anymore. I thought I was going to look at those results and be all like "Yep its Hashi's, lets get those TSH levels around 1, and suck it up". I just gave myself more questions.

My PCP didn't even talk to me this time, she gave me vit D and upped my thyroid meds and referred me to the only Endo in the area, and shes got a 7 month waiting list.  a county with well over 50k people has 1 endocrinologist.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> Ok, it says
> TBI 4352 (B)-to see note B
> 
> note B says TBG 28.6 13.5-30.9 mcg/ml
> ...


If you go to the link I provided of ANA, you will see that ANA is suggestive of thyroid but not what exactly. Further testing is needed.

ANA only confirms that further in-depth and specific testing is needed.

TBI (Thyrotropin-Binding Inhibition) There is that binding immunoglobulin I was talking about.
http://jcem.endojournals.org/content/52/4/665.abstract

Here it explains how TBI interferes with lab results (TSH)
http://www.ncbi.nlm.nih.gov/pubmed/45474

Where there is TSI, you usually find TBI.

Wondering what your doctor's comments are?

Yeah; you started a new thread so I did not have your medical history. The problem is identifying the Hurthle cells. Did pathologist say Hashi's?? There are Hurthle cells indigenous to cancer and Hurthle cells indigeneous to Hashi's. If it is confirmed Hashi's then you do have Hashi's.

As you know,I most certainly am not a doctor and you have some complicated things going on re antibodies and immunoglobulins. So, I for one will be very interested in what your doctor thinks.

I have a hunch though; these immunoglobulins are mostly present in Graves'. Sometimes in Hashi's too but they are "sisters in the hood" as they say.


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## ScaredAJ (Jun 3, 2011)

From the FNA

"FNA results

5 spray fixed smears for pap stain 5 air dried smears for dq stain. fluid for cell block

No malignant cells identified 
Cellular aspirate containing blood, many lymphocytes, macrophages including multinucleated macrophages and follicular cell groups, some of which have a hurthle cell appearance.

Cell Block 
blood lymphocytes and occasional macrophage.

*Comment: Cytologic findings suggest chronic lymphocytic thyroiditis, please correlate with clinical laboratory and imaging findings"*


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## ScaredAJ (Jun 3, 2011)

Also my PCP didn't give an opinion she referred to an endo. I have to wait 7 months to see her though we only have 1. I am going to have to travel and find one that takes my ins.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> From the FNA
> 
> "FNA results
> 
> ...


Yeah..................if we were in your original thread, all that info would have been handy. I remember now.

The pathologist says that you do have Hurthle cells indigenous to Hashimoto's. Thyroiditis and Hashimoto's are used interchangeably. Why they use them interchangeably in the same breath is way beyond me.

So..........................as you know, sometimes those with Hashi's do end up w/Graves'.

Conversion from hypothyroidism due to Hashimoto's thyroiditis into Graves' hyperthyroidism in a case of thyroid hemiagenesis

http://www.endocrine-abstracts.org/ea/0016/ea0016p128.htm

So anyway........................even though I have a hunch based on the presence of the TSI, TBI and TGB; this is way out of my field of expertise.

I don't want to give out misinformation here so we better wait and see what the doc has to say about all this.


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## ScaredAJ (Jun 3, 2011)

Going to have to read that better. Hashi and Graves, yuck. I do have symptoms of both.

Sorry, I am confusing with the starting of new threads I get excited, and don't think clearly  Thank you for your continuing to listen to me  I means a lot to know that I'm not alone, and people so understand how poorly I feel. I felt shoved to the bottom of the barrel again when my PCP just told me I needed to see an endo, and didn't want to talk about the test results. It tends to make you feel un-wanted, or at the very least unimportant.

All of you have been a great help in dealing with this and put hope into a situation I deemed hopeless. For far too long I let my family suffer with me being ill, and I will have my life back. My family deserves to have me back.

I *pray* that the Endo in the area squeezes me in, and doesn't make me wait out the 7 months.

I really cant thank you all enough for the support! I look forward to reading these boards daily, and am like a kid in a candy store when I'm waiting on replies LOL Thank you all. :hugs:


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## Andros (Aug 26, 2009)

ScaredAJ said:


> Going to have to read that better. Hashi and Graves, yuck. I do have symptoms of both.
> 
> Sorry, I am confusing with the starting of new threads I get excited, and don't think clearly  Thank you for your continuing to listen to me  I means a lot to know that I'm not alone, and people so understand how poorly I feel. I felt shoved to the bottom of the barrel again when my PCP just told me I needed to see an endo, and didn't want to talk about the test results. It tends to make you feel un-wanted, or at the very least unimportant.
> 
> ...


Hey; I get excited too and often very very upset for and behalf of our wonderful posters such as yourself and others who are not receiving the proper medical intervention much less a proper diagnosis.

I hate you have to travel for an endo and worst of all, you could be disappointed in that on top of it.

We are here for you; myself especially. I will do all I can to help you.

Have you gotten on cancellation lists? I am praying with you.

Wish I had a magic wand so I could make "all" right w/ the world. I "really" do!


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## webster2 (May 19, 2011)

ScaredAJ said:


> Going to have to read that better. Hashi and Graves, yuck. I do have symptoms of both.
> 
> Sorry, I am confusing with the starting of new threads I get excited, and don't think clearly  Thank you for your continuing to listen to me  I means a lot to know that I'm not alone, and people so understand how poorly I feel. I felt shoved to the bottom of the barrel again when my PCP just told me I needed to see an endo, and didn't want to talk about the test results. It tends to make you feel un-wanted, or at the very least unimportant.
> 
> ...


Hello! I sure will pray that you don't have to wait 7 months for an endo appointment, goodness. You deserve to have yourself back too. It is hard not being yourself, isn't it? We'll get better! The help & support here is wonderful. I am glad you are a part of that! Is it possible for a family member or friend to go with you to your appointments? Best, Sue :hugs:


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## ScaredAJ (Jun 3, 2011)

If I have to travel out of town it will be an all day trip, so I will need a traveling partner!

Depends on the area I have to travel. I am between John Hopkins and WVU, both are about a 3 hour trip depending on traffic and time of year. I will give the Endo 1 week to fit me in, and if she can't then my PCP will have to send me to JH or WVU, and I get a date for the day  Hopefully this is something that either hospital can manage from here LOL, so I dont have to go back every 6 weeks for blood work. I can't take time off work like that either. Thank you all though!


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## ScaredAJ (Jun 3, 2011)

Great News! My lab results went to the endo on Tuesday, and they called me that day and have me coming in FRIDAY! I got past the waiting list!!

Whats sad is I feel really good today compared to what I have been. I just hope she understands it all comes and goes as it pleases! hugs4


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## ScaredAJ (Jun 3, 2011)

I know I should have a list of questions, but with feeling good comes in the scattered unorganized side of my brain.


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## bigfoot (May 13, 2011)

It's sure easy to forget how bad we feel at times when you finally are feeling good. Don't worry about it, just enjoy it!


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## Andros (Aug 26, 2009)

ScaredAJ said:


> Great News! My lab results went to the endo on Tuesday, and they called me that day and have me coming in FRIDAY! I got past the waiting list!!
> 
> Whats sad is I feel really good today compared to what I have been. I just hope she understands it all comes and goes as it pleases! hugs4


What wonderful news!! Your happiness has triggered the endorphins!! Momentary feel good! LOL!!

Good luck tomorrow and I know each of us is anxious to hear all about your endo visit!


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## ScaredAJ (Jun 3, 2011)

Seen the Endo today, I have a lot to take in. I have Hyperlipidemia, along with EBV that is active, and has been running wild, along with my Hashi's, and she said I have Chronic Fatigue.

I was given two diets and a list of vitamins to take, and she also seems to think that I am diabetic and need testing for that as well. She also said that my labs are 100 % Hashi related. All of my symptoms point to the EBV, CFS, and Hashi. She was also said that all masses over 1 cm need biopsied and that any change in them at this point forward that does not indicate shrinking, will need to be dealt with. She wants my TSH around .3 but i have to work on this diet for the EBV and CFS first. She said I will feel worse before better, but better becomes fantastic. So this is going to be HARD. No sugar, gum (even sugar free) no soy, 6 ounces of lean meats a week no more, no nuts, no avocado, no CHOCOLATE, or sweets, or caffeine.

I feel very UGH about it, I'm accepting it, but I am not liking it at all. lol :sad0049:hugs2


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## Andros (Aug 26, 2009)

ScaredAJ said:


> Seen the Endo today, I have a lot to take in. I have Hyperlipidemia, along with EBV that is active, and has been running wild, along with my Hashi's, and she said I have Chronic Fatigue.
> 
> I was given two diets and a list of vitamins to take, and she also seems to think that I am diabetic and need testing for that as well. She also said that my labs are 100 % Hashi related. All of my symptoms point to the EBV, CFS, and Hashi. She was also said that all masses over 1 cm need biopsied and that any change in them at this point forward that does not indicate shrinking, will need to be dealt with. She wants my TSH around .3 but i have to work on this diet for the EBV and CFS first. She said I will feel worse before better, but better becomes fantastic. So this is going to be HARD. No sugar, gum (even sugar free) no soy, 6 ounces of lean meats a week no more, no nuts, no avocado, no CHOCOLATE, or sweets, or caffeine.
> 
> I feel very UGH about it, I'm accepting it, but I am not liking it at all. lol :sad0049:hugs2


Do you realize how lucky you are to have found this awesome and very knowledgable doctor?? OMG!! To die for!

It is not hard to feel better; capiche'? You do as she says. I have been doing that and more for many many years and I feel great. I am 68 and believe me, I can work circles around women 1/2 my age.

Do you drink coffee? I put Hersheys' 100% dark Chocolate powder in my coffee about every other day. I never ever crave chocolate and the dark stuff is really good for you.

Anyway, don't do anything I say, do what your doctor says. She is on a mission to make you well.

I also have active EBV re periodontal. I was shocked. Perio told me that and so I had doctor run a test and dang; there it was, the dormant variety from having had it a long time ago reared it's ugly head. Perio put me on Valtrex.

You can do this and I will help you from afar. It's a head thing; get it goin' on in your head.

I am so impressed; I can't stand it. I kid you not!


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## ScaredAJ (Jun 3, 2011)

*hugs* Yes she is a very great doctor, and is very passionate about my health. There were a lot of tears today hers and mine, because for once I had a professional sitting in front of me telling me that I was normal, understanding my pain, and frustration, and caring about how I feel as a whole.

It was truly amazing. It was an appointment that took 3 hours, and that was her going over things with me. She answered all my questions, and even got upset at the lack of care I was given by other doctors.

She is a fantastic doctor and refuses to look at me with tunnel vision. I have so much to be thankful for.

I'm not allowed coffee at all and I am a huge coffee fan. I will be okay, as hard as it is, I will do it because I will feel better. She did order tests, 5 of them to be done over the next 6 weeks, at different times. The glucose tolarence test, the FNA on the right nodule, and the blood tests that I would normally have ran.

I am totally being a baby about the diet, i will adjust  hugs6:hugs:


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## northernlite (Oct 28, 2010)

No Chocolate?!?!?! I don't think that would be possible for me!


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## ScaredAJ (Jun 3, 2011)

Got the biopsy results, and I don't know what to think. The said the results said thyroiditis AND Follicular neoplasm. There was a lot of swelling in my cells. Its 50/50, the pathologist didn't say one or the other but both. The combination of calcification, hurtle cell, and this new set of labs has me being sent to a general surgeon. I am actually just not sure what to think. I don't understand anything anymore


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## ScaredAJ (Jun 3, 2011)

So I guess the next step is surgery. Thats the only other option I have to know for sure. Now the question is will he take half or all, since I already take levo, there would be no reason to take half of a not working gland right?

Im still confused, is it normal for hashi cells to mimic cancer cells? Wouldn't more hashi pts have this same issue or am I missing something? Did i misunderstand what she was saying?


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## bigfoot (May 13, 2011)

My own personal opinion is this... take the whole damn thing out! 

Honestly, I don't see what difference it makes having half a thyroid remaining. You still have to take thyroid medicine from here on out for life. You still have to follow-up with doctors and lab work on a regular basis.

They are already going in there, prepared to operate and remove the thyroid, why not take it all and give you some peace of mind for the future? You wouldn't have to worry about the other remaining half possibly becoming cancerous, and you wouldn't need to have surgery again, along with its own risks, costs, and recovery time.

That is, of course, just my $0.02.


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## ScaredAJ (Jun 3, 2011)

If I have to do it I only want to do it once. I guess its time to wait for the surgeon's opinion. I don't think there are any other "tests" we can do to determine if this is cancer or not, but removing it and testing it. I'm okay with them taking the whole thing.


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## bigfoot (May 13, 2011)

I think that's a wise choice. (I know I've already made up my mind in case it comes to that.)

Something else I've seen mentioned here is to make sure the surgeon has a LOT (as in 100's a year) of thyroid surgeries under their belt to reduce the risk of harming the parathyroid glands, and any other possible complications.

Good luck with the consult! hugs6


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## ScaredAJ (Jun 3, 2011)

thanks! i have to wait until the 11th.


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## webster2 (May 19, 2011)

ScaredAJ said:


> So I guess the next step is surgery. Thats the only other option I have to know for sure. Now the question is will he take half or all, since I already take levo, there would be no reason to take half of a not working gland right?
> 
> Im still confused, is it normal for hashi cells to mimic cancer cells? Wouldn't more hashi pts have this same issue or am I missing something? Did i misunderstand what she was saying?


My .02, if you are going to have part of it removed; you might want to consider having all of it removed. I had part taken out 20 years ago, and will have the rest removed in a couple of days. I would have rather had one surgery, and be done with it. I think I was fine about 18 years but in the last 2 years, it has been strange, and not at all living life as I normally do. Once again, JMHO. I hope you will feel better soon.


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## ScaredAJ (Jun 3, 2011)

I have hit a low today.

I went to my surgeons appointment, and he said he would recommend a total removal and scheduled me for the 6th of september. 
I went and had all the pre surgery tests done... another ultrasound, ekg xrays, blood, you name it we did it.

I got a call this morning they cancelled my surgery (rescheduling to take place later today or monday) and he wants me to have a 131 scan, and I have to stop all of my thyroid meds for 30 days in order to be able to do it.

A month with out medication scares me. My hashi's is going to have a field day, and i already suffer from chronic fatigue. Why would he order the test now, and still be removing the thyroid. why now? it doesn't matter, the scans not going to help them learn anything. The scan cant tell if its cancer, if the biopsy didn't, right? I am just so confused.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> I have hit a low today.
> 
> I went to my surgeons appointment, and he said he would recommend a total removal and scheduled me for the 6th of september.
> I went and had all the pre surgery tests done... another ultrasound, ekg xrays, blood, you name it we did it.
> ...


Uptake scan can tell a lot; better to be safe than sorry. Sounds like the surgeon is being very careful and taking good care. That is what I would like to think, anyway.

There is no reason why they cannot Rx you Cytomel, about 5 mcg. just to get you through. You would then stop it one week prior to RAIU.

http://www.pfizer.com/files/products/uspi_cytomel.pdf

However, a thought has occurred. Do you think they are trying to milk your insurance for all it is worth? I sort of side w/you in that just get it out and send it to pathology.

Did you ask the surgeon why he wants you to have the uptake now?

Let us know if you go to battle over this and how you make out.


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## ScaredAJ (Jun 3, 2011)

I dont think this is insurance related.

I am having a full body 131 scan done that takes 2 days. I can not have any hormone replacement at all, they said.


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## ScaredAJ (Jun 3, 2011)

everything says that the thyroid should be removed BEFORE the 131 full body scan. what is going on.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> everything says that the thyroid should be removed BEFORE the 131 full body scan. what is going on.


Wow!!! It's the weekend so you can't call to find out now but I am with you. I would like to know also!!

Are you okay? You sound really upset. I sure can understand why but do know that we are here for you.


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## ScaredAJ (Jun 3, 2011)

I am upset, because no one answered me before they left for the weekend. What they are doing makes no sense so I am scared out of my mind. I keep freaking myself out. I'm also not looking forward to a month with no medication, and try to work full time.

I'm scared that what is happening isn't curable and i get to wait, more. I waited since May to figure out what was going on with me and now I can't get "too late" out of me head.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> I am upset, because no one answered me before they left for the weekend. What they are doing makes no sense so I am scared out of my mind. I keep freaking myself out. I'm also not looking forward to a month with no medication, and try to work full time.
> 
> I'm scared that what is happening isn't curable and i get to wait, more. I waited since May to figure out what was going on with me and now I can't get "too late" out of me head.


I sure can appreciate that. Don't know how you will be able to function off meds. Not a good scenario. You may have to firstly find out all the information you can and why they have change the course as per previous plan.

You may have to put your foot down.

Read this link...........

In an effort to decrease the amount of time that you must be hypothyroid, a short-acting form of thyroid hormone called T3 (the most common brand name is called Cytomel) is given after you stop taking your regular, long-acting form of the medication (T4). The T4 or levothryoxine is stopped 6 weeks prior to the scan so that it may be eliminated from the bloodstream. At that time, T3 is started and is continued until 2 weeks prior to the scan.

http://www.cumc.columbia.edu/dept/thyroid/raiprep.html

And these; sounds like the full body scan is done after the surgery etc..

http://jcem.endojournals.org/content/87/4/1499.full

After initial therapy of differentiated thyroid carcinomas, in most cases thyroidectomy and iodine-131 ablation of residual thyroid tissue, long term follow-up is currently based on periodic whole-body scintigraphy and serum thyroglobulin (Tg) determination. Both best performed after an adequate period without replacement therapy.
http://brighamrad.harvard.edu/Cases/jpnm/hcache/1026/full.html

http://www.thyca.org/pap-fol-treatment.htm

This is quite clear; can copy and paste PDF. It says you MUST have the thyroid removed BEFORE the whole body scan.

http://medicalcenter.osu.edu/PatientEd/Materials/PDFDocs/diagnost/nuclear/toti131.pdf

Hope this stuff helps you when you discuss this Monday with your doctors.


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## ScaredAJ (Jun 3, 2011)

So WOW, what a ride this has been!

SO many ups and downs, but my fight with my thyroid is now over. I had my total removal the 15th of September. My skin has returned to its normal color, I feel 200% better. I have lost weight in just this little bit of time. I couldn't be happier.

I got the pathology reports back, and it turns out that I did in fact have Papillary cancer in both lobs, that were completely encapsulated. In fact because of the size 2.5 cm and 1.5 cm both are called Micro papillary carcinoma.

Its going to be just fine!

I am having issues with my calcium, and now take 2 grams of calcitrol and 8 Tums a day now, and we think it may be permanent but, oh well. Its better than being full of cancer cells. This happened because the left side of my thyroid was totally calcified and required the use of stronger tools to get it out. a 1 day stay turned into 5, but I am cancer free, so its worth it!! hugs4. Thank you all for being such a support to me.


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## Andros (Aug 26, 2009)

ScaredAJ said:


> So WOW, what a ride this has been!
> 
> SO many ups and downs, but my fight with my thyroid is now over. I had my total removal the 15th of September. My skin has returned to its normal color, I feel 200% better. I have lost weight in just this little bit of time. I couldn't be happier.
> 
> ...


I cannot tell you how good it is to hear from you and aren't you glad you got that thyroid out?? Oh, my gosh!!! Just think if no one discovered the problem!!

Did they have to take out a couple of your parathyroids? How is the incision looking? Are you on thyroxine replacement yet?

5 days in the hospital; staggers the mind! But, you are here, you sound happy and I know we are all grateful that you are fine, will be fine and will get your life back!


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## ScaredAJ (Jun 3, 2011)

I am so thankful its gone!!!!

They did not take any parathyroid glands, but we may have damaged or shocked one. It was quite a painful recovery! I wasn't able to take the pills for pain, so it was rough. After the 3rd day they started crushing them in apple sauce!

Its bothersome that 2 separate biopsies did not detect papillary cancer! I'm glad I made the choices that I did. My body knew it was much more than Hashimoto's!

This incision looks fantastic! He did a great job in that aspect. He also put me back on my 150 mcgs of levothyroxine when I left the hospital. My Endo is off taking her new boards at the moment but she took the time to call me today and tell me what I should be doing next, which is the 123 then 131. All that takes place in December.

I am feeling tons better already, and I feel me getting my old self back soon enough.

It was a rough couple months but my head is above water now! *HUGS*

Even the pain is going away, how fantastic! .. Its just amazing!


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