So what did all the test show?

Late September Testing Update

For the week of September 27, I underwent a series of tests to see where things stand with my thyroid cancer.

Sept 27: Blood work, a Thyrogen injection (artificial TSH to stimulate any thyroid cancer cells), and a neck ultrasound.

Sept 28: Second Thyrogen injection. Within hours my voice became very hoarse. Nurses, doctors, and my own searches haven’t seen this listed as a side effect.

Sept 29: PET scan and 3.9 mCi of radioactive iodine.

Oct 1: Whole-body scan.

Lab results: TSH is where it should be (0.03). Free T4 is 1.3 (slightly high). The troubling number is Thyroglobulin (TG). Four years post-thyroidectomy it should be 0; anything >10 suggests recurrence. Mine is 81. I thought my prior TG was 40 (which would be bad because it’s rising), but the only value found in the system was 160 (which would mean it’s falling). Either way, only thyroid cells make TG, so something is still out there.

Ultrasound: No changes from six months ago.

Whole-body scan: Report says no neck uptake (though I saw a little when viewing the images). Uptake in the bladder is expected because iodine clears via urine. If not for the TG level, this would look reassuring. Since nothing lights up, the disease may have mutated to a non-iodine-avid form, which is harder to treat.

PET scan 101: PET uses a radioactive sugar to show how fast cells are burning glucose. Cells that burn sugar too quickly can be suspicious for cancer.

PET findings: A faint focus in the inferior right thyroid bed (SUV max 2.3; was 2.6), and a faint increased uptake in the distal esophagus (SUV max 3.8). The thyroid-bed spot is being followed and is smaller; surgery there risks my voice due to prior staples. The esophagus finding is more concerning—it could be distant thyroid cancer metastasis (low survival odds) or a new, unrelated cancer. I’m not sure what two unrelated cancers would mean for me.

Next step: I hope to see a gastroenterologist next week to start work-up on the esophageal finding.

Next: New Doctor

Previous: A few thought while I am waiting.