Which Specialist to Consult for Rising Thyroglobulin Levels?

Which outpatient clinic should I go to?

This year, my thyroid antibody index for Thyroglobulin seems to be continuously rising.
After receiving high-dose I-131 treatment, my immunoglobulin levels were stable at 1-2 for several years, but suddenly increased to 10 at the beginning of the year and reached 12 in July.
The thyroid hormone medication I’m taking is causing my heart rate to exceed 100 beats per minute, which is quite uncomfortable.
The internal medicine and family medicine clinics can help prescribe thyroid hormones and perform blood tests to check TSH and fT4 levels, but the original surgical team prefers not to prescribe medication from a distance.
They insist on continuing to monitor my blood work.
The surgical team will check Tg levels and perform ultrasounds but seem unconcerned about my rapid heartbeat.
I would like to ask the doctor: after thyroid surgery, should I follow up with internal medicine, surgery, or nuclear medicine? Does the increase in immunoglobulin levels indicate that I might need another painful iodine scan or treatment that could result in loss of taste? Is it really not sufficient to just receive thyroid hormone medication at a small clinic? Am I at risk of recurrence?

Niming, 20~29 year old female. Ask Date: 2020/11/17

Dr. Ke Fangxu reply Surgery

Have you undergone a total thyroidectomy due to malignant thyroid tumors after receiving Iodine-131 treatment? Iodine-131 destroys all thyroid tissue, so future sources of thyroid hormones must come from oral supplementation.
Rapid heartbeat may be due to elevated thyroid hormone levels, so it is necessary to re-evaluate thyroid function to determine whether it is a recurrence or simply excessive supplementation.
Follow-up can be done in either the surgical or metabolic medicine department, while the nuclear medicine department should assess the subsequent treatment goals to decide if further evaluation is needed.

Reply Date: 2020/11/17

More Info

When dealing with rising thyroglobulin (Tg) levels after treatment for thyroid cancer, it is essential to consult the right specialist to ensure proper management and follow-up. In your case, given the history of high Tg levels and the treatment with radioactive iodine (I-131), the most appropriate specialist to consult would be an endocrinologist, particularly one who specializes in thyroid disorders.
Thyroglobulin is a protein produced by the thyroid gland, and its levels are often monitored in patients who have undergone treatment for thyroid cancer. An increase in Tg levels can indicate the presence of residual thyroid tissue or recurrence of cancer, which is why it is crucial to monitor these levels closely. The fact that your Tg levels have risen from 1-2 to 10 and then to 12 is concerning and warrants further investigation.

While your primary care physician or family medicine doctor can manage your thyroid hormone replacement therapy and monitor basic thyroid function tests (like TSH and free T4), they may not have the specialized knowledge required to interpret rising Tg levels in the context of thyroid cancer. An endocrinologist can provide a more comprehensive evaluation, including the interpretation of Tg levels, the necessity for imaging studies (such as ultrasound), and the potential need for further treatment.

In terms of your concerns about the potential for recurrence and the need for additional treatments, it is important to understand that rising Tg levels do not automatically mean that cancer has returned. However, they do indicate that further evaluation is necessary. The endocrinologist may recommend additional imaging studies or a biopsy if they suspect recurrence.
Regarding your symptoms of increased heart rate while on thyroid hormone replacement therapy, this is a common issue, especially if the dosage is too high. It is essential to communicate these symptoms to your healthcare provider, as they may need to adjust your medication dosage. An endocrinologist can help you find the right balance in your thyroid hormone replacement therapy to alleviate symptoms while maintaining appropriate hormone levels.

As for your concerns about undergoing further treatments like radioactive iodine scans, it is understandable to feel anxious about the potential discomfort and side effects. However, the decision to pursue additional imaging or treatment will depend on the results of your evaluations and the recommendations of your healthcare team.
In summary, for rising thyroglobulin levels after thyroid cancer treatment, you should consult an endocrinologist who specializes in thyroid disorders. They will be able to provide a thorough evaluation, manage your thyroid hormone therapy, and guide you through the necessary steps to monitor your condition effectively. It is crucial to address both your rising Tg levels and your symptoms of increased heart rate to ensure comprehensive care.

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