July 20, 1998 -cancer.net
Follow-Up of Treated Thyroid Cancer after Recombinant TSH-Stimulated Testing
Since the patient's last visit, there have been no new local neck symptoms--the patient denying anterior neck pain, tenderness, swelling, hoarseness, cough, hemoptysis, dysphagia, or dyspnea. There have there been no new symptoms suggesting pulmonary, thoracic, skeletal, or neurological metastases.
The patient has had no complaints of thyroid hormone excess, denying tremor, palpitations, weight loss, heat intolerance, or unexplained anxiety. There have been no symptoms suggesting hypothyroidism, denying cold intolerance, constipation, dry skin, impaired mentation, or depressed mood.
The patient's general health has otherwise been good. Review of all other systems is negative.
On Monday and Tuesday of this week, the patient received 0.9 mg recombinant thyrotropin IM. There was no nausea, headache, local or other reaction after the rTSH dose. 123-I PO was given on Wednesday and a radioiodine whole body scan was performed today.
I reviewed the results of that scan today, along with a detailed review of the patient's previous relevant medical records, laboratory results, and imaging reports. The current scan shows only physiological regions of tracer activity; there was no focal tracer concentration suggesting residual thyroid tissue in the thyroid bed or cervical, intrathoracic, skeletal, central nervous system or other metastases.
These findings were reviewed with the patient, whose questions about the study and its implications were answered in detail.
Alert and clinically euthyroid. P 72 regular. Skin warm and dry. HEENT: no lid lag or periorbital edema
Neck: trachea midline; well-healed thyroidectomy scar; no palpable thyroid tissue, lymphadenopathy, or other mass. Ext: no tremor, normal muscle strength
ASSESSMENTS:
Well-differentiated epithelial thyroid carcinoma, with no clinical, laboratory, or radionuclide scan evidence of recurrent disease.
Postsurgical hypothyroidism, clinically and biochemically adequately replaced on current thyroxine dose.
PLANS:
Continue current thyroxine dose
Await results of rTSH-stimulated serum thyroglobulin level. If this is undetectable, follow-up clinical and laboratory evaluation will be arranged in 6-12 months.
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