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khagihara, Doctor
Category: Medical
Satisfied Customers: 6590
Experience:  Trained in the multiple medical fields for many years.
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My tsh level is >20 and its normally suppressed as I had

Customer Question

My tsh level is >20 and its normally suppressed as I had total thyroidectomy 9 years due to thyroid cancer
Submitted: 1 year ago.
Category: Medical
Expert:  khagihara replied 1 year ago.

Are you on the thyroid medication?

Customer: replied 1 year ago.
100 levothyroxine
Expert:  khagihara replied 1 year ago.

Are you aware of anything which might have triggered it? Any recent medical problems? Any recently surgeries? Any recent medications? Any symptoms?

Customer: replied 1 year ago.
No, I'd been feeling tired which is why I had an early test I haven't had my cancer marker ones done yet, I know tsh should be suppressed after total thyroidectomy for cancer over 20 seems high?
Expert:  khagihara replied 1 year ago.

When were the tsh measured? When it was measured, were you on levothyroxine?

Customer: replied 1 year ago.
It was measured last week, and yes I've already answered re levothyroxine and as I said I had it tested as I wasn't feeling well.
Expert:  khagihara replied 1 year ago.

You should have levothyroxine increased. The TSH level should be at or slightly below the lower half of the reference range (0.3 to 2.0 mU/L).

Customer: replied 1 year ago.
I know that I wanted to know how bad it is being at over 20 and does that pose a risk for the cancer coming back, you have just told me what I know
Expert:  khagihara replied 1 year ago.

What is the exact name of the thyroid cancer? When did you have it measured before last week?

Customer: replied 1 year ago.
I had papillary and 4 months ago and it was suppressed
Expert:  khagihara replied 1 year ago.

The hypothesis that reduction of serum TSH concentrations to below the normal range decreases morbidity and mortality in all patients with differentiated thyroid cancer such as papillary cancer has not been proven, but at least one study suggested improved relapse-free survival when serum TSH concentrations were undetectable during follow-up. In another report from a multicenter prospective tumor registry, greater TSH suppression was associated with improved progression-free survival in high-risk papillary cancer patients. The follow-up report from that registry indicated that lowering TSH levels aggressively was associated with improved overall survival in high risk differentiated cancer patients, whereas milder degrees of TSH suppression were still associated with excellent outcomes in patients with low risk features, eg, less than 45 years of age at diagnosis with primary tumors greater than 4 cm or gross extrathyroidal invasion and in patients older than 45 years at diagnosis with primary tumor sizes between 1 and 4 cm, multifocal disease, or microscopic extrathyroidal invasion. Most patients with papillary cancer do not die of their disease. However, a number of factors have been identified that are associated with a higher risk for tumor recurrence and cancer-related mortality. The most important prognostic factors are older age at diagnosis (≥45 years), size of primary tumor, and the presence of soft tissue invasion or distant metastases. However, the high TSH for 4 months could cause recurrence. You should have serum thyroglobulin concentrations checked and ultrasound of the cervical lymph nodes, the most common site of recurrent papillary thyroid cancer.