# PLEASE explain thyroglobulin testing to me!



## kat92 (Apr 22, 2013)

Long story short..

Still have my thyroid. Have some nodules. Biopsied, and came back as "FLUS". (was follicular neoplasm, but another lab that saw my slides "downgraded" it to this FLUS diagnosis)

Anyway..
yesterday I asked about possibly having hashimotos...and they thought I'd already had all that kinda bloodwork done, which I hadn't.

A previous ENT started me on 88mcg of Synthroid, which is working GREAT!! The lump I initially felt, I barely feel now! I don't have the fatigue like I was having, and even my hair has stopped falling out!

So anyway, they did bloodwork yesterday, and I finally called today to see exactly what they were running. The nurse told me Thyroglobulin and some antibody thing. And I said "ok, well do any of those show cancer as far as results."? She said thyroglobulin is a tumor marker and that with the antibody will show if anything is "going on in there". WHAT!?????:confused0079:

So somehow this blood test COULD tell me whether I have cancer or not? I didn't think any blood test could!? I know AFTER you've had your thyroid out they run some of these tests to see if you have a re-occurance, etc.

But.....what about people who still have their thyroid, just have nodules, and no "definitive" cancer diagnosis from a biopsy? Will these tests show cancer on people like that? (Me?)


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## joplin1975 (Jul 21, 2011)

No thyroglobulin cannot be used to determine definitively if you have cancer.



> Thyroglobulin is a protein made by the thyroid gland. Measuring the thyroglobulin level in the blood can't be used to diagnose thyroid cancer, but it can be helpful after treatment. A common way to treat thyroid cancer is to remove most of the thyroid by surgery and then use radioactive iodine to destroy any remaining thyroid cells. These treatments should lead to a very low level of thyroglobulin in the blood within several weeks. If it is not low, this might mean that there are still thyroid cancer cells in the body. If the level rises again after being low, it is a sign that the cancer could be coming back.


http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-diagnosis

You will have some level of thyroglobulin because you still have your thyroid.



> Thyroglobulin is the protein precursor of thyroid hormone and is made by normal well differentiated benign thyroid cells or thyroid cancer cells. Although thyroglobulin levels may be elevated in patients with thyroid cancer, a large number of benign thyroid conditions may also be associated with elevated levels of thyroglobulin, hence an increased thyroglobulin alone in a patient not known to have thyroid cancer is not a sensitive or specific test for the diagnosis of thyroid cancer. Simply examining the thyroid or carrying out a thyroid biopsy can produce significant elevations in the circulating blood level of thyroglobulin. Similarly, patients with thyroid inflammation can have very high levels of thyroglobulin. Patients without a known diagnosis of thyroid cancer do not generally benefit from having the levels of thyroglobulin measured. Some patients with antithyroglobulin antibodies may have inaccurate thyroglobulin levels measured in the lab if the antibodies interfere with the assay, but this is uncommon.


http://www.mythyroid.com/thyroglobulin.html

It's just one more piece to the puzzle but is in no way definitive.


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## kat92 (Apr 22, 2013)

Never fails...just when I think I can kind of relax, something else comes up.

Now this thyroglobulin stuff!! 

What's really gonna be bad, is if they don't have answers for me tomorrow, I will have to wait till Tuesday to know anything. :sad0016:

Making it worse YET....is my daughter and I leave tomorrow night for a trip to Vegas. Supposed to be fun.....but if I have this hanging over my head, it'll be anything but fun.

The not so friendly nurse I talked to a little bit ago, said she "thought she told me it takes 2 or 3 days to get it back, because they have to send it out".

Great. No..you did NOT tell me that. H*ll I didn't even know what test they were running, let alone how long to get it back!?!


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## abymom99 (Apr 15, 2013)

Based on what I've read on this, and what joplin posted, I'm not sure why you're worried about this. It sounds completely useless unless they're using it as a potential cancer marker after TT and radioactive idodine treatment:



> Patients without a known diagnosis of thyroid cancer do not generally benefit from having the levels of thyroglobulin measured.


Joplin - Perhaps you can enlighten me. If this is elevated by both benign and cancerous nodules, then what's the point if you know you have a nodule, or other thyroid issue for that matter? Everything that I've read on this test makes it seem completely useless, again unless you're post-cancer treatment and looking for further cancer cells.


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## joplin1975 (Jul 21, 2011)

The way I understood it is like this:

It is elevated when your thyroid is being destroyed, be it by cancer or by an autoimmune process. If you don't have a confirmed autoimmune disease, you still have your thyroid, and you have elevated levels of Tg, then that raises a red flag. Not a definitive test, but certainly would take someone in limbo and maybe gently push them towards surgery.

For someone with an autoimmune condition, you are right...it's kinda useless. They never ran it on me prior to my surgery because they knew it would be sky high. Still, I suppose if you have TPO and other antibodies (TSI or TRAb) and you also have high Tg levels, the doctor might just throw up his hands and say "Let's take the sucker out because hormone replacement is going to be futile."


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## Octavia (Aug 1, 2011)

Here's a good explanation:
http://labtestsonline.org/understanding/analytes/thyroglobulin/tab/test


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## abymom99 (Apr 15, 2013)

Thanks Joplin, that makes a lot more sense to me now. I have very high TPOab's which is why it would probably useless then for someone like me.

Octavia - That was one of the descriptions I had read also, but it still didn't clarify to me why it would be useful to anyone other than for post-cancer treatment, and now I see for determining the effectiveness of Grave's treatment. I'm referring to the section called "What does the test result mean?". It just seems to be pretty useless for about 90% of the population (ballpark estimate of course ).


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## kat92 (Apr 22, 2013)

ok, putting the thyroglobulin test itself aside....can I assume that my thyroid antibodies will probably be positive? ...only saying that because of my positive ANA test I had a couple weeks ago. I still have a strong feeling that is linked to my thyroid!!

I don't have a "diagnosed" autoimmune thyroid condition. This is this first antibody test of any kind that has been done! They've tested, tsh, free T3, and 4. But that's been it as far as thyroid function.

So if the doctor calls me tomorrow and says "your antibodies are positive"... then what??? Am I still safe to wait until september to re-evaluate? Because even positive antibodies don't for SURE say it's cancer, correct? And being on Synthroid to calm things down should help a little right? Something is evidently working because like I've said, this original "lump" that sent me running to the doctor, has shrunk so much now, I have to work hard to even find it!


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## Octavia (Aug 1, 2011)

Okay...let's try to put this in perspective. Your nodule has shrunk. You're feeling good. And your doctor said not to worry and to re-check later, which is a great plan. Lots of positives there. AND you have a fun trip planned for the weekend.

If you have antibodies, my guess is you and your doctor will just keep an eye on things, monitor how you are feeling, and go from there.

I just get the feeling that you are making this a lot more stressful than it needs to be. Are you able to let go of the worry at all so you can relax?


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## kat92 (Apr 22, 2013)

Octavia said:


> Okay...let's try to put this in perspective. Your nodule has shrunk. You're feeling good. And your doctor said not to worry and to re-check later, which is a great plan. Lots of positives there. AND you have a fun trip planned for the weekend.
> 
> If you have antibodies, my guess is you and your doctor will just keep an eye on things, monitor how you are feeling, and go from there.
> 
> I just get the feeling that you are making this a lot more stressful than it needs to be. Are you able to let go of the worry at all so you can relax?


I have fleeting moments that I'm like "eh...whatever" and I can relax. but then the panic comes back. I think because I've had about 5 different diagnosises from 3 different doctors.

However, you are correct. If I put things in perspective, it's not so bad. As usual for me, ....it's the "not knowing" that drives me nuts. This is just one more stupid test I don't have an answer for.

I do hope no one tries to take my Synthroid away from me for some reason. I'm lovin this stuff. Wish I would have had it a couple years ago. I forgot what it feels like to not be exhausted by 4pm every day!!!! 

And yes, very excited from the trip with my daughter!! Lots of eating planned. arty0049: AND............we have tickets to the Fleetwood Mac concert at the MGM.


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## Octavia (Aug 1, 2011)

oooohhhh...let us know how you like the Fleetwood Mac concert - I'm betting it will be great!

Here's the thing...there will ALWAYS be unknowns. No matter what. Forever. And that sucks. But life isn't perfect, and we have to learn to live with the unknowns and not be consumed by them (which sucks even worse than the unknowns). I'm hoping that since you're feeling good on the Synthroid and your nodule has shrunk, you'll start to have a lot more "eh...whatever" days, and a lot fewer moments of panic!

:hugs:


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## kat92 (Apr 22, 2013)

Thank you!

And yep, I will try and report back about the concert!  haha! arty0036:


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## I DClaire (Jul 31, 2011)

My papillary cancer, hidden deep in my thyroid, was 1 millimeter in size. It was basically the size of the end of a pencil lead, totally encapsulated and removed intact...but I will have the thyroglobulin tumor marker test every four months for five years.

On February 22, 2012, I had lab tests that would later be suspected of being handled poorly BUT by the time I drove home from the lab, they had a result, they had called my endocrinologist who called me because the thyroglobulin tumor marker result was 5.5!

Later, I remembered that the lab technician had dropped the vial of blood and told my endocrinologist who said that would have compromised the test.

My other results have all been (with range being 0), 0.2 or 0.3.

I asked my doctor about the test early on and she said it would detect or suggest that a thyroid cancer cell was somewhere in my body.

Here, ANY diagnosis of thyroid cancer keeps a patient seeing the endocrinologist (not a PA) for five years. I also get ultrasound tests of the thyroid bed.

I've often wondered how anyone could have found anything 1 mm in size in my grossly oversized, diseased thyroid then produced a very lengthy biopsy report about it but these tests don't scare me, they reassure me and I feel blessed to get them.


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## kat92 (Apr 22, 2013)

I DClaire said:


> My papillary cancer, hidden deep in my thyroid, was 1 millimeter in size. It was basically the size of the end of a pencil lead, totally encapsulated and removed intact...but I will have the thyroglobulin tumor marker test every four months for five years.
> 
> On February 22, 2012, I had lab tests that would later be suspected of being handled poorly BUT by the time I drove home from the lab, they had a result, they had called my endocrinologist who called me because the thyroglobulin tumor marker result was 5.5!
> 
> ...


When you say your doctor told you it would detect or suggest thyroid cancer cell somewhere in your body, are you referring to AFTER you had thyroid surgery? Because from what I've read so far the thyroglobulin is useless before surgery...since everyone that has a thyroid, has thyroglobulin!!

(If Im reading all these right...?? Im so confused anymore!)


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## joplin1975 (Jul 21, 2011)

Oh, goodness, please....please for me, don't ruin your weekend worrying about this because OMG Fleetwood Mac?? I'm so dang jealous! :-D


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## kat92 (Apr 22, 2013)

joplin1975 said:


> Oh, goodness, please....please for me, don't ruin your weekend worrying about this because OMG Fleetwood Mac?? I'm so dang jealous! :-D


I know I know.  I'm going to try and remain calm. I figure if I wanna worry, I'll at least put it off until next week when we're back from vegas!!


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## kat92 (Apr 22, 2013)

Drumroll......

****

Thyroglobulin was "normal"! It was 11, and antibodies were..... UNDETECTABLE!!! yay!!! Thanks for all the pep talks and reassurance. I can definitely enjoy the Vegas trip now!


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## ives6797 (Apr 23, 2013)

Antibodies? Is that what they look for for hashi's? Does that mean they don't suspect hashi's now?


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## kat92 (Apr 22, 2013)

I've never been "diagnosed" with Hashis. It's just one of the ideas the last ENT was throwing around. This is the first antibody screening they've done on me. I'm on synthroid for symptoms more or less. Have all the hypothyroid symptoms..... And some elevation in Tsh


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