# normal thyroglobulin with elevated thyroglobulin antibodies = recurrence?



## Boilermkr08

i'm a newbie to the boards but not to thyroid disease/cancer. i'm driving myself nuts looking for information, thoughts on my current situation...

brief background - i had a total thyroidectomy May 2010 following the diagnosis of Papillary Thyroid Cancer. At the time it had not spread to my lymph nodes. was treated with I-131 RAI and scans and labs came back where they should be. fast forward almost a year and i was displaying symptoms that had me concerned - my doctors bumped up wbs by a month and everything came back negative.

fast forward to the beginning of october - i went in for an 18 month check and the dr said i was considered in remission and that he wanted a US done for mapping purposes for the future, i also had bloodwork done that day after my appointment. I got a call a couple days later saying my labs were abnormal because, while my thyroglobulin levels where where they should be, my thyroglobulin antibody level was elevated to 64 (normally i believe is <20.0). so i went to my US and they found 2 enlarged lymph nodes (2cm each) and one that was borderline and requested an FNA (one lymph on each side). the cytology came back negative for the nodes but they ordered a thyroglobulin washout. I know with the presence of antibodies TAg is not an accurate tumor marker (it can create a false low) and supposedly with this washout they can detect thyroglobulin in the presence of antibodies.

my questions are 1. has anyone experienced this before? 2. is the presence of these antibodies in an elevated state a "symptom" of a recurrence? 3. are there really any symptoms of recurrence? i've been feeling awful, having recurrent migraines (again! i would get them ALL the time before my TT), wicked dry skin, my weight loss has stopped dead in it's tracks and i've been gaining even though i'm sticking to my meal plan and exercise program, dry skin etc... yet my TSH is where it needs to be (even though i've lost 25 lbs and my dr was convinced prior to running those labs that my synthroid would have to come down...

Any thoughts anyone?


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## lainey

Antibodies are not a tumor marker, if you have them they interfere with the test that measures thyroglobulin post-surgery. They usually test you for these before your surgery even, because they want to know in advance if you have them, and having your thyroid removed does not generally cause them to disappear.

If the washout showed no thyroglobulin (the tumor marker) you are probably good in that area. Additionally, traces of thyroid are generally easily detected in the WBS if you follow the diet/use thyrogen/ etc, so the negative results there should give some confidence that you are "clean".

Your symptoms are more likely related to 1.) an illness that resulted in the enlarged lymph nodes (and this could be any low grade infection) 2.) inadequate thyroid hormone replacement (what are your most recent lab results with ranges?) 3.) other deficiencies (iron, vitamins)

What do your labs look like?


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## Boilermkr08

i know the thyroglobulin is the tumor marker and antibodies are not and i know the presence of antibodies can mess with the thyroglobulin levels. there has been a spike in the thyroglobulin antibodies though - and it should be that those levels actually decrease over time (not necessarily go away altogther) but again, there has been a spike in the past 3 months. I haven't gotten the results for the washout yet - 2 weeks i guess...

as for the the rest of my labs...my calcium is low (i take supplements anyway due to complications from TT) so thats a constant for me - but everything else was fine - TSH was in the range it should be in (which my doctor thought for sure he'd have to lower my synthroid because i lost 25 lbs), AND i'm not sick with anything - no colds, sinus issues, allergies...

it's truly weird. i'm just wondering if anyone else has had a spike in thyroglobulin antibodies post cancer treatment and it ended up being a recurrence


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## corn

I just got mine back today as well, same thing High 266.0 ..waiting to hear..total thyroidectomy almost a year ago. Feeling like crap too!


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## Andros

corn said:


> I just got mine back today as well, same thing High 266.0 ..waiting to hear..total thyroidectomy almost a year ago. Feeling like crap too!


Did you have cancer when you had the total? If so, did you have follow-up RAI?

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419


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## Andros

Boilermkr08 said:


> i know the thyroglobulin is the tumor marker and antibodies are not and i know the presence of antibodies can mess with the thyroglobulin levels. there has been a spike in the thyroglobulin antibodies though - and it should be that those levels actually decrease over time (not necessarily go away altogther) but again, there has been a spike in the past 3 months. I haven't gotten the results for the washout yet - 2 weeks i guess...
> 
> as for the the rest of my labs...my calcium is low (i take supplements anyway due to complications from TT) so thats a constant for me - but everything else was fine - TSH was in the range it should be in (which my doctor thought for sure he'd have to lower my synthroid because i lost 25 lbs), AND i'm not sick with anything - no colds, sinus issues, allergies...
> 
> it's truly weird. i'm just wondering if anyone else has had a spike in thyroglobulin antibodies post cancer treatment and it ended up being a recurrence


Did you have follow-up RAI?


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## Andros

Boilermkr08 said:


> i'm a newbie to the boards but not to thyroid disease/cancer. i'm driving myself nuts looking for information, thoughts on my current situation...
> 
> brief background - i had a total thyroidectomy May 2010 following the diagnosis of Papillary Thyroid Cancer. At the time it had not spread to my lymph nodes. was treated with I-131 RAI and scans and labs came back where they should be. fast forward almost a year and i was displaying symptoms that had me concerned - my doctors bumped up wbs by a month and everything came back negative.
> 
> fast forward to the beginning of october - i went in for an 18 month check and the dr said i was considered in remission and that he wanted a US done for mapping purposes for the future, i also had bloodwork done that day after my appointment. I got a call a couple days later saying my labs were abnormal because, while my thyroglobulin levels where where they should be, my thyroglobulin antibody level was elevated to 64 (normally i believe is <20.0). so i went to my US and they found 2 enlarged lymph nodes (2cm each) and one that was borderline and requested an FNA (one lymph on each side). the cytology came back negative for the nodes but they ordered a thyroglobulin washout. I know with the presence of antibodies TAg is not an accurate tumor marker (it can create a false low) and supposedly with this washout they can detect thyroglobulin in the presence of antibodies.
> 
> my questions are 1. has anyone experienced this before? 2. is the presence of these antibodies in an elevated state a "symptom" of a recurrence? 3. are there really any symptoms of recurrence? i've been feeling awful, having recurrent migraines (again! i would get them ALL the time before my TT), wicked dry skin, my weight loss has stopped dead in it's tracks and i've been gaining even though i'm sticking to my meal plan and exercise program, dry skin etc... yet my TSH is where it needs to be (even though i've lost 25 lbs and my dr was convinced prior to running those labs that my synthroid would have to come down...
> 
> Any thoughts anyone?


Oh, wow!!! Have they been keeping your TSH suppressed? I never heard of this wash-out and will be very interested to know the outcome.

Keeping you in my thoughts and prayers for all of this.

I am sure you know all this but I found this and will post it that it may benefit our readers.

http://www.ncbi.nlm.nih.gov/pubmed/17006842


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## Andros

Boilermkr08 said:


> i'm a newbie to the boards but not to thyroid disease/cancer. i'm driving myself nuts looking for information, thoughts on my current situation...
> 
> brief background - i had a total thyroidectomy May 2010 following the diagnosis of Papillary Thyroid Cancer. At the time it had not spread to my lymph nodes. was treated with I-131 RAI and scans and labs came back where they should be. fast forward almost a year and i was displaying symptoms that had me concerned - my doctors bumped up wbs by a month and everything came back negative.
> 
> fast forward to the beginning of october - i went in for an 18 month check and the dr said i was considered in remission and that he wanted a US done for mapping purposes for the future, i also had bloodwork done that day after my appointment. I got a call a couple days later saying my labs were abnormal because, while my thyroglobulin levels where where they should be, my thyroglobulin antibody level was elevated to 64 (normally i believe is <20.0). so i went to my US and they found 2 enlarged lymph nodes (2cm each) and one that was borderline and requested an FNA (one lymph on each side). the cytology came back negative for the nodes but they ordered a thyroglobulin washout. I know with the presence of antibodies TAg is not an accurate tumor marker (it can create a false low) and supposedly with this washout they can detect thyroglobulin in the presence of antibodies.
> 
> my questions are 1. has anyone experienced this before? 2. is the presence of these antibodies in an elevated state a "symptom" of a recurrence? 3. are there really any symptoms of recurrence? i've been feeling awful, having recurrent migraines (again! i would get them ALL the time before my TT), wicked dry skin, my weight loss has stopped dead in it's tracks and i've been gaining even though i'm sticking to my meal plan and exercise program, dry skin etc... yet my TSH is where it needs to be (even though i've lost 25 lbs and my dr was convinced prior to running those labs that my synthroid would have to come down...
> 
> Any thoughts anyone?


Bless your heart; you have been through it for sure!


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## corn

yes papillary carcinoma w hashimotos no further treatment after surgery other than thyroid replacement..I dont see doc for follow up appt for 2 more weeks...having all the symptoms of hashimotos but i was unware that i could still have this after the surgery...feeling very frustrated that i have the surgery to hope to feel better, get rid of the cancer, take meds and vitamins everyday to only feel the same


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## corn

Andros said:


> Did you have cancer when you had the total? If so, did you have follow-up RAI?
> 
> Thyroglobulin Ab and cancer
> http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf
> 
> Another Thyroglobulin and cancer
> http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419


Yes papillary carcinoma ....no treatment after surgery other than thyroid med...levels ok..antibodies high only show signs of hashimotos even after surgery...very frustrating to still be dealing w this ..appt in two weeks to discuss labs ugh...


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## Andros

corn said:


> Yes papillary carcinoma ....no treatment after surgery other than thyroid med...levels ok..antibodies high only show signs of hashimotos even after surgery...very frustrating to still be dealing w this ..appt in two weeks to discuss labs ugh...


TPO Ab is "suggestive" of many things and also it may be too soon for them to go down and away.

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

TPO Ab should be negative, 0
http://www.medlabs.com.jo/docs/Leaflet-17.pdf
(The normal thyroid has TPO but should not have antibodies to TPO)

Keep the faith; all will be well. It takes time; you have been through a lot.

Let us know how that appt. goes.


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## corn

Too soon? I had my total thyroidectomy 11 months and no other treatment? I would think they be gone or at least low? Hate feeling in limbo not know plan of treatment or options. Thanks for your responses


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