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samdah

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Goddess Forever
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Edge,

I saw my thyroid doctor today for an update. He was unaware that I had been instructed by my oncologist not to have my ovary out.

He agreed that my thyroglobulin level of 9.1 was low (he has a patient currently who registered with a level of 206), but since there had been some uptake in my ovary last year and then a little bit more uptake there this year, he thought it was significant enough to remove the ovary. He talked to my gynecologist and breast surgeon who agreed.

However, after my oncologist found this out, he went and talked to my gynecologist and breast surgeon and they all agreed that I should not have it out.

My thyroid guy said it is okay not to do anything now, but next spring when they do the tests, if anything points to there being uptake in the the ovary, he will demand that my ovary be removed.

I don't really care either way, but I am just a little ticked off at all the differing opinions. I plan to discuss this with my oncologist when I see him for my next herceptin treatment and see what he says again.

Frustrated!

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edge

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Samdah:

I can well appreciate your frustration in having to deal with dueling - and changing opinions in what should be integrative team management, and you definitely want the breast and thyroid oncologists to coordinate your care between them and not have unnecessary dissonance aired out in front of you as it were. There is a lot of confusion among professionals as to the association between various reproductive / hormonal factors like post-menopausal status and oophorectomy on the one hand and risk of thyroid cancer, especially papillary type, on the other, stemming largely from an earlier Los Angeles County study which was first to suggest an adverse association, and I suspect that some possibly muddled thinking about this association may have played a role in some of the decisions relayed to you. But in any case I have found this study unconvincing and the subsequent research data inconsistent.

In addition, I am unable to discern the significance of anyone noting to you that the thyroglobulin number is low in magnitude; what matters is not the magnitude, but the trajectory - it is rising, rather than stable or decreasing, thyroglobulin levels following I-131 ablation that are a preferential predictor of persistent or residual disease (and even a level of 206, if part of a declining, or rock stable, readings series would be considered unproblematic; I wouldn't lose any sleep if the levels hovered steady, and if declining, I go out and celebrate regardless of the magnitude of the number itself).

Finally the two threads of the relevance and potential benefit of estrogen suppression for thyroid cancer versus for breast cancer must be separated. Whatever anyone's perspective on this for thyroid cancer, both surgical or medical ovarian ablation is unquestionably favorable to outcome survival in breast cancer, an especially important point to bare in mind when it is remembered that mortality from thyroid cancer is relatively muted compared to the much more serious mortality concerns of breast cancer, from which - unless individual factors dictate otherwise - I would consider the breast carcinoma component of joint thyroid / breast cancers to be the primary driver of overriding therapeutic decisions.

We'll see what your oncologist says in the near future.


Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

samdah

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Goddess Forever
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Reply with quote  #3 
Thank you so much!

I talked with my thyroid doctor again on Friday. He called me with my TSH results which were .19 which is where he would like me to be.

He said that if he was to put money on it, he would put money on my ovary not having anything wrong with it. But, he still feels I should consider removal.

I will talk with my oncologist about it again. I think he is just trying to minimize the amount of surgery I have right now. I had my lumpectomy in 2003, my thyroidectomy in 2006, and then the mastectomy in 2007. Tomorrow I go in for my implant exchange surgery. So, I think he would prefer that I wait on additional surgery unless it is absolutely necessary.

For now I have the Lupron and hopefully that will take care of my ovary for the time being.



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