TSH and recurrence

Hi All,
I'm new to this forum. I got TT for Papillary carcinoma (with two lymph nodes metastases) in July and RAI in October. Right now I'm on Euthyrox of 125mcg and TSH below 0.1.

Ia there any body can tell me if this is true:
there is no active cancer or recurrence as long as the TSH maintains below 0.1?

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Not true.

A suppressed TSH means that there is a limited amount of stimulating hormone in your system which could, if there are thyroid cells remaining, encourage a recurrence. TSH only tells you what your pituitary gland senses -- the lower the TSH, the more thyroid hormones the pituitary detects in the body. It is in no way an indicator of active cancer growths or recurrence.

Thyroglobulin (along with TgAB) is generally the only bloodwork-based test used in post-TT cases to monitor recurrences.

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Hi tmr100, I think you're thinking of Tg (thyroglobulin) and not TSH (thyroid stimulating hormone). Tg is used as a molecular marker of thyca recurrence after TT. It's a protein made by thyroid and thyca cells.

Keeping TSH suppressed -- by having enough thyroid hormone in your system -- is a preventive measure against recurrence, since too much TSH stimulates any thyroid and thyca cells.

One important caveat: If you have Tg antibodies (TgAbs), as in Hashimoto's, then the trend in the antibody levels would be looked at for recurrence along with Tg, since Tg alone could read falsely negative when antibodies are present.

All the best to you!

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Thanks a lot to emmaleah and joplin1975 for your quick replies. It's so helpful your info for me to understand it better. My endo will send me for Tg and TgAbs in 7 month from my RAI, which I hope it's not to late....

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Not necessarily. But if you are referring to an undetectable Tg (which varies from lab to lab as to what constitutes "undetectable"), then the correct phrase that should be used is "no evidence of disease." Doctors that say "no cancer" are making a terribly bold and often misleading statement.

T4 and TSH have an inverse relationship. The higher your T4 dose (Synthroid, etc), the more the pituitary backs off, sending less and less TSH. By having a low TSH (Thryoid Stimulating Hormone), you are minimizing stimulation of any thyroid cancer cells or even normal thyroid tissue that might possibly still be hanging around. So, high T4 (Synthroid, etc.) with a higher level of free T4 on blood test will result in a lower response from the pituitary and you wind up with a low or "suppressed" TSH.

Many doctors focus only on TSH, but if you feel awful and your free T4 level is way up near the top of the range, you are likely too suppressed and could use a small dose reduction. Doctors need to look at the free T4 and free T4 to have the real picture. In the hands of a skilled and experienced endocrinologist this is as much "art" as it is science. The art is understanding your patient, wanting to optimize their quality of life and having the skill to keep working at it.

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PS TSH <.1 is optimal treatment for high risk thyroid cancer patients, and many doctors use <.1 for the at least the first two years of treatment to manage the disease. The recurrence rate is higher during the first 2 years, so keeping you suppressed can be a good game plan. But suppressing to extreme levels like .006 or .002 is not needed unless you are high risk or high risk with persistent disease. Something like TSH .04-.09 is adequate suppression for medium risk patients, especially the first year. Low risk patients can actually be allowed to have a higher TSH (.3 - 2.0), but that usually doesn't happen for close to a year for many low risk patients. Doctors are just not risk takers when it comes to cancer. Over the first year with Tg testing and ultrasounds, you and your doctor can get a better idea of how best to manage you longer term. Good luck!

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I read note from emmaleah. Does that mean if your antibodies are rising that your Tg reading is inaccurate. My tg is 0.9 but for the first time I have antibodies, where do they come from and what does that mean?

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I am just curious to know as to what does TgAb <10 imply. Does this range of TgAb affect the Tg result in anyway. Can a high Tg result of 17.4 be accurate in the presence of this TgAb <10.

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That means you do not have any antibodies that would skew the results of your Tg test. Which means your Tg test is likely accurate.

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Thank you for your response. In the Lab Test Results (4 times from the same lab) it mentions that
my Tg 17.4 is within the Reference Range (0.0 - 20) for patients who have had T/T. Since mine falls within the
range, what does it imply. My TSH is suppressed to 0.1 and my Free T3 and T4 are within the range. I am a
bit cautious not to overtreat and get into unwanted problems and mess ups. For you information, I had my recent
ultrasound of the neck, WBS and Chest xray and all came out clean.

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HI Cabro,
thank you so much so such clear explanation. " over suppressed" is likely my situation now : free T4 is a bit over the high range with TSH below 0.1 which is demanded by my endo for my case. However I am feeling too much energy and hard to feel sleep. Hope it's getting better by time.....

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I had a TgAb of 100 and TG undetectable after T/T and before the RAI. My surgeon told me after the surgery that I had Hashimoto's thyroiditis as with the cancer. Hashimoto can also cause TgAb high, and high TgAb could cause false Tg low. Than's one of the reason why he sent me for RAI. Is there any one who used to have cancer& Hashimoto?

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Cabro…Are you saying that Hashimoto's does not go away after TT? We still have it in our system and requires treatment? I'm confused…Help.

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Hashimoto's does not go away...but the target of the autoimmune attack has been removed so things tend to "simmer down."

sanjay5, I would be concerned with a Tg that high. I aim for under 2.0.

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my surgeon told me for those who have cancer with Hashimoto actually have a lower chance of recurrence, according to statistics. I didn't ask him why as my knowledge of TC was so poor at the beginning. I tended to listen to the good thing only........

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tmr1000,
I was dx with both PTC and Hashi's in 1982. I have not ever had RAI treament and was not kept suppressed. I am suppressed now with TSH .047. Just last week I had a RAI tracer dose WBS and the doctor told me that I did not need RAI after the results came back. I have rising TG (2.1) and Tgab (153.1) so I am interested in answers.

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jkittie,
have you ever tested for TG and TgAb? How much is the rising from you previous test? According to my doctor
TG testing can be complicated (make it lower) by the presence of TgAb . For us who have TgAb positive, a better strategy is to not rely on any single testing but to follow several ones by time. It is important, my endo mentioned to me to go always the same Lab for Tg and TgAb, as different labs use different methods of test. Ask your doctor for the best Lab specializing in Cancer Marker testing. To test Tsh or FT4/FT3, you can go any lab.

Would like to hear what your doctor suggests about your rising TG.

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The rising Tg (numbers in last post) was the reason she ordered an US and a WBS ( plus I have never had one). Tg was undetectable and Tgab was 40 four months ago. Same lab but different assay. I am still waiting to hear from her and to get my stimulated Tg from last week.

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I always understood it as the THS is what would feed the cancerous cells.....My Endo wanted me suppressed and stated that even though my Tg was undetectable if we suppressed the THS it may starve any remaining thyroid cancer cells.

My Endo at Hopkins (I have 2) told me that people often get confused with the word reoccurrence in thyroid cancer.......I'll never forget he said.....It is NOT a reoccurrence, the cancer has always been there......for people that get RAI.....well the RAI just didn't kill it all......sometimes it takes years to show up or become significant enough to detect it. I remember my him repeating over and over to me......even though you may have cancer in your lymph nodes, it may never become clinically significant....... RAI generally does not work on lymph nodes.....sometimes it does.

The tricky thing about this cancer is most Endo's will find something then say wait.......it's a hard pill to swallow.

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