1. My radioactive iodine dose and WBS were scheduled for Monday 6/13 and Wednesday 6/15 respectively. Isn't the usual protocol to do Thyrogen shots on Monday and Tuesday, scan dose on Wednesday, then WBS and Tg blood draw on Friday? Wouldn't a scan dose on a Monday put my Thyrogen shots on a Saturday and Sunday? This is the protocol that we have been using for several years, due to availability of nurses during the week, so the shots are administered on the weekend. We are working on changing the procedure. If you want to have the shots done on a different day…. No, not a problem. I can stick to the current schedule, but where do I go for the shots on a weekend? Urgent Care. Ok. Didn’t even think about that, but that makes sense. We’ll give you a handout on the Thyrogen procedure before you leave today.
2. Were my ultrasounds in December & January 'extensive or careful' neck ultrasounds, where all levels, including 2-6 on both sides, were checked? If not, can I have one done this year, and could it be part of my follow-up plan going forward? I am confident in the skill of our ultrasound technicians, that they would be checking all areas that need to be looked at. If you want, you can ask them if they are looking at levels 2 through 3 (what about 4-6?) during your next ultrasound. I think ultrasounds uncover more insignificant lymph nodes; the stimulated Tg is the more important test.
3. My FT4 is finally in range. Did the addition of T3 bring down my FT4 levels, or did that happen on its own? Now that I am taking T3, should my blood work also include either T3 or FT3? Your FT4 is finally in range because we lowered your medication. T3 is very potent. But my TSH is lower than before, it is <.01. TSH should be undetected. It is not much lower than before, but we want it to be low and suppressed. We should stay with your current meds. Great, because I need to get a refill, but wasn’t sure if I should my current prescription or not.
4. If I lose a significant amount of weight (20+ lbs), will my meds needs to be changed? He didn’t answer this question.
2. Were my ultrasounds in December & January 'extensive or careful' neck ultrasounds, where all levels, including 2-6 on both sides, were checked? If not, can I have one done this year, and could it be part of my follow-up plan going forward? I am confident in the skill of our ultrasound technicians, that they would be checking all areas that need to be looked at. If you want, you can ask them if they are looking at levels 2 through 3 (what about 4-6?) during your next ultrasound. I think ultrasounds uncover more insignificant lymph nodes; the stimulated Tg is the more important test.
3. My FT4 is finally in range. Did the addition of T3 bring down my FT4 levels, or did that happen on its own? Now that I am taking T3, should my blood work also include either T3 or FT3? Your FT4 is finally in range because we lowered your medication. T3 is very potent. But my TSH is lower than before, it is <.01. TSH should be undetected. It is not much lower than before, but we want it to be low and suppressed. We should stay with your current meds. Great, because I need to get a refill, but wasn’t sure if I should my current prescription or not.
4. If I lose a significant amount of weight (20+ lbs), will my meds needs to be changed? He didn’t answer this question.
Other stuff he said:
-I mentioned before that your prognosis is good. You are “Stage I” because you are under the age of 45. Your Tg and TgAB are both undetectable. I predict that your WBS in June will most likely be clear. If you feel that confident about your prediction, who do you think will win the Super Bowl next year because I’d like to put money on that……(hahaha)
-For your WBS, Thyrogen shots on Saturday & Sunday, scan dose on Monday, WBS on Wednesday. Make sure you get the stimulated Tg blood draw after your WBS – tell them you only need the Tg drawn. So Tg blood draw on Wednesday 6/15? Yes. Tg only. We will call you at the end of June with the WBS and Tg results. A stimulated Tg level at <2 is good.
-July follow up ultrasound with a visit the following week. Let’s confirm that appt with Gwen. Before your July appt, let’s do another Thyroid panel. You have standing orders for these, but let’s update those, add Total T3 for your July blood draw. We may change your meds, but will do so after your WBS. Your blood draw in July, with the Total T3, will help me to determine which way I need to change your meds, if necessary.
-What will my follow treatment be going forward? Blood work, maybe another follow up ultrasound in 6 months. Then yearly blood draws for TSH and Tg. If your WBS is negative, no more scans. If stimulated Tg is <2, we probably won’t repeat it.
-How are you feeling with the addition of T3? It was added to help with some mental (I’m thinking to myself at this point ‘hold up buddy, when did I call them mental issues? I was just having problems remembering words/things/my point when I am talking!’) issues, fatigue. Things were going pretty well the first month. But at the end of last month I was in San Francisco for a meeting and I couldn’t complete my sentences. I don’t know if it had anything to do with the stress of the day – wet, rainy SF day, big meeting – or if it was the meds not working. Tiredness….I’ve always had a problem with that, so I don’t think it would change with the added T3. I’ve been sick the past week, so it is hard to compare how I’ve been feeling recently. I guess it is working. I feel good otherwise. How are your periods? Are they consistent now? It was coming every 4 weeks, but last month it was only 3 weeks. I think it is probably going to stay around the 3-4 week cycle.
So, it was a good appt. I think I’m a lot less anxious at my ENDO appts now. Even if I still have questions about things, I am not as worried about them now as I have been in the past. I’m sure this makes me a more relaxed patient to have to deal with.
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