# Pathology report after TT



## ariabel (Jul 29, 2013)

So I just got my final pathology report and there's a whole lot of stuff on it that I need to decipher. The doctor did a so/so job of explaining it but I know I have to wait to see my endo to fully understand it. Of course, I'm too impatient to wait that long.

Should I post here, maybe someone can help me try to understand this wording?


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## joplin1975 (Jul 21, 2011)

Yup, go ahead and post it!


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## ariabel (Jul 29, 2013)

OK - there are two areas that seem similar, so I'll just put the part that says 'Final Pathologic Diagnosis'

Thyroid, Total thyroidectomy
Multifocal papillary carcinoma, classic type involving right and left lobe and the isthmus (i understand this!)

the foci of papillary carcinoma range in size from less than 1 mm to 1.3cm (i understad this!)

the largest mass involves left lobe (i understand this!)

the isthmus and left lobe nodules infiltrate the thyroid capsule and extend into the perithyroidal soft tissue (don't understand!)

focal lymphovascular and perineural invasion is identified (this is scary!)

tumor is present at the ink margin of resection (WTF?)

HELP


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## joplin1975 (Jul 21, 2011)

Ok, so...the doctors are trying to steer away from using RAI with *everyone* who has PTC. The idea being why expose someone to radiation if their tumor is encapsulated and hasn't travel outside the thyroid capsule.

Unfortunately, yours is not encapsulated and did a wee bit of traveling. Because you don't have "clear margins," it is very likely you have cancerous thyroid cells still in your neck.

I know, it sounds scary, but here's the good thing: you had classic PTC. No scary variants which can be no-avid (meaning, the cells don't absorb the RAI) to radioactive iodine. So, while it's not ideal, ideal, it's very, very manageable. Insist on RAI and make sure (no matter what your docs say) that you do the LID two weeks before your treatment.

The short story: you need a little more treatment, but in the long run you will be FINE!


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## ariabel (Jul 29, 2013)

Thanks Joplin 

My doctor did strongly suggest RAI, but he was the surgeon and I guess it's my endo that really does all the work from here. I see her Friday so I will know more then.

I asked him when I would be started on the synthroid and he said she will probably start me Friday. I asked him about the low iodine diet and he said something about an alternate way to do it where I would get some kind of shot before the RAI. He didn't really go into it and just said it would be something the endo decides based on what she thinks will work best for me. Do you know anything about this "other way" of doing it?

I appreciate your help  It's hard to find anyone to talk to about this. I'm glad these boards exist!


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## Velcro (Jul 26, 2013)

Joplin is so good  I'm glad you are going to receive proper treatment. Please write down any questions for your Endo that you think of the next couple of days because from experience, if I don't, when they start throwing stuff at me, I tend to forget what I wanted to ask.


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## joplin1975 (Jul 21, 2011)

Thyrogen is the shot you get to artificially elevate your TSH (you want that TSH way up, as it stimulates the residual cells, making them absorb the radioactive iodine).

When I had my RAI, I went hypo "naturally" and did not do the LID. Now, I do thyrogen + the LID for my scans (and treatment if needed). The LID is new for my doctors protocol but even if he didn't require it, I think I would still do it. To tell you the truth, I regret not doing it for my initial therapy dose. By no means am I any kind of expert, but I've done a bunch of reading on LID vs. no LID and as far as I can tell, it goes like this: for some people, it makes no difference, but for others, it really does seem to maximize the effectivess of the treatment. For that reason, I can't help but think "why not do it?" It's a pain, but if you don't mind cooking and can get creative, it's not bad at all.


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## ariabel (Jul 29, 2013)

I totally agree with you. I did a little reading about it as well, as far as why your body needs to be depleted of iodine, and it makes a lot of sense. I think I will do that either way, just to be sure.

I hope they give me all the rest of what I need to know tomorrow. Its been two months since I found out I had thyroid cancer, and it seems like it's the slowest medical process ever!


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