Wednesday, January 05, 2005

The Diagnosis of the Recurrent Thyroid Cancer in Neck Nodes

The 35 Y/O female patient had total thyroidectomy and Radioiodine ablation one year ago. She had a low risk 2 cm well differentiated papillary cancer without spread and no positive Lymph nodes. She was on TSH suppression with LT4 for the year. Her neck exam was negative to palpation, however her thyroid cancer ultrasound found two nodes. One
in the lateral neck, and the other at the angle of the jaw. Both were on the side of ther original surgery. Ultrasound Guided biopsy of the nodes, included a washing of the needle into saline for Thyroglobulin,( TG ). Tg is the cancer marker for thyroid cancer. The needle biopsy slides were negative for thyroid cancer in both nodes, however, the Tg was 19,000, for the node by the thyroid bed, but was < 0.3 in the node at the angle on the jaw. The washings helped decide that surgery was indeed, needed. Washing the needle for thyroglobulin is a new and necessary part of biopsy protocol for suspected thyroid cancer lymph nodes.


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