# Metastasis - How Many Years?



## sstewart1 (Jan 20, 2015)

Good Morning,

I am a 35-year old female. I was diagnosed with Papillary Thyroid Cancer in 1994 at the age of 14.

I had my thyroid completely removed, and underwent Radioactive Iodine treatments, as the cancer spread to my lungs.

I've maintained regular followup over the years with my endocrinologist, and had annual bloodwork, scans, ultrasounds, etc.

I did two rounds of Thyrogen shots with accompanying full-body scans, and all has been well, with the exception of one "odd" looking lymph node in my neck, that we've been keeping an eye on for the last several years. Its proximity to the jugular vein has prevented a biopsy up until this point, but there's been no changes (i.e. change in size or shape) to the node over the last three years, so we continue to watch it.

For the last two weeks, I've had a very tender spot on my upper left rib cage. It only hurts when you specifically press on the spot, or in the shower if I happen to brush up against it. It doesn't hurt on the other side. The pain has gotten no worse and no better over the last few weeks. I've not had any upper respiratory infections, no accidents, muscle strains (that I can think of), etc.

I'm fairly certain it's not heart pain (good thing right?) and it doesn't feel like muscle pain either - it feels like bone pain.

I've read online about Costochondritis, and it sounds very familiar. I realize that more than likely, the cause is completely benign, but given my history with metastatic thyroid cancer, I feel that I should have it checked out. My husband thinks I'm a hypochondriac, but I would feel better having it checked.

My question is, am I a hypochondriac? Is it medically feasible that a metastasis could show up so many years later, or am I completely freaking myself out about nothing? What kind of doctor should I see about this? Should I request an appointment with my endocrinologist, or should I see an orthopedist? I don't have a GP at the moment. Thoughts?


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## joplin1975 (Jul 21, 2011)

I don't think you are a hypochondriac at all!

When was your last whole body scan? When was your last Tg/TgAB bloodwork? Who manages yours scans and medication? I would go to that doctor first and then figure out next steps.


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## sstewart1 (Jan 20, 2015)

Thanks for the quick response Joplin!

Last whole body scan was in 2012. Last bloodwork was done in October 2014 - everything was great.

My endocrinologist manages all tests and medication....I left them a voicemail, as I was thinking that would be a good place to start as well.

I just hate bugging doctors over something that turns out to be nothing, but I'd hate to NOT bug them and have it turn out to be something, you know?

Any idea how many years post treatment that any sort of metastasis has been discovered? I tried doing some research online, but it doesn't offer much in the way of results. I found one website that said it could appear "decades" later, but that seems overkill to me?

Ahhh well, I've requested an appointment with the endo, so we'll see what she has to say. I was really just looking for someone to tell me I wasn't crazy for wanting it checked out!


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## Andros (Aug 26, 2009)

Welcome to the board! With your history; do not take a chance. See your doctor about this right away.

Always follow the very first instinct you have. It usually always is the correct one!

God bless and let us know!


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## joplin1975 (Jul 21, 2011)

sstewart1 said:


> Any idea how many years post treatment that any sort of metastasis has been discovered? I tried doing some research online, but it doesn't offer much in the way of results. I found one website that said it could appear "decades" later, but that seems overkill to me?


Well, if you don't have a substantial rise in Tg (without the presence of TgAB), the likelihood it's thyroid cancer is very slim. YAY! Thyroid cancer is very slow growing and it would be very unusual for it to jump to your lungs without seeing a steady rise in the Tg number. But I think its an excellent idea to get it checked out.

You'll see research that's all over the place with regard to risk of recurrence or metastasis. From what I can tell, there are a lot of studies that say the first two years after treatment tend to have lots of recurrences...and then you see another little "bump" at about the 20 year mark. But those are very, very general trends.


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## jenny v (May 6, 2012)

I'll agree, you're not a hypochondriac! You had thyroid cancer that spread to your lungs--you have a right to be concerned about anything new that pops up.


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## Lovlkn (Dec 20, 2009)

> My question is, am I a hypochondriac?


Nope - I would call you "aware" and with your history definitely having it checked out is what you should be doing.


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## sstewart1 (Jan 20, 2015)

Thank you to all who took to time to respond and reassure me that I'm not crazy!

I'll follow up with the endocrinologist, and let you all know how it goes.


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## sstewart1 (Jan 20, 2015)

Hi All,

Just wanted to update - saw the endocrinologist, had a chest x-ray, and she diagnosed me with costochondritis - basically, take some Advil, and suck it up, LOL!

They went ahead and did bloodwork while I was there as well, and I have one more quick question regarding the results.

I've always thought that high-risk patients should maintain their "suppressed" TSH levels (< .1). However, my TSH is .62 and the doctor said that's "normal"?

TSH = .62 mIU/mL (normal range .46-4.98)

T3 = .7 ng/mL (normal range .8-2.0)

FT4 = 1.1 NG/DL (normal range .7-1.8)

Thyroglobulin Antibodies = < 1 IU/mL (normal range < or = 1)

Thyroglobulin = .1 ng/mL (normal range 2.8-40.9)


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## joplin1975 (Jul 21, 2011)

I think a TSH or .62 is actually ok at this point especially with the Tg and TgAB results you have (which are good!). Technically speaking, you should be below 0.5 at this point, but you are awfully close. What were your other more recent TSHs?

http://www.thyca.org/pap-fol/more/tsh-suppression/

For long-term management, the guidelines recommend (Recommendation 49):


In patients with persistent disease, the serum TSH should be maintained below 0.1mU=L indefinitely in the absence of specific contraindications.
*In patients who are clinically and biochemically free of disease but who presented with high risk disease, consideration should be given to maintaining TSH suppressive therapy to achieve serum TSH levels of 0.1-0.5mU=L for 5-10 years.*
In patients free of disease, especially those at low risk for recurrence, the serum TSH may be kept within the low normal range (0.3-2mU=L).
In patients who have not undergone remnant ablation who are clinically free of disease and have undetectable suppressed serum Tg and normal neck ultrasound, the serum TSH may be allowed to rise to the low normal range (0.3-2mU=L).


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## Lovlkn (Dec 20, 2009)

> TSH = .62 mIU/mL (normal range .46-4.98)
> 
> T3 = .7 ng/mL (normal range .8-2.0)
> 
> FT4 = 1.1 NG/DL (normal range .7-1.8)


You still should be shooting for 3/4 range for FT-4 and FT-3. Total 3 tracks with FT-3 and you are below range which is concerning and it is likely causing hypo symptoms.

FT-4 is also lower than 3/4 of range which is 1.53.

Other than the chest pain - how do you feel?


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