Yes, it matters.
My impression from my surgeon yesterday was that since the tumor was verysmall (3.5mm) and it wasn't near the margin of the thyroid that RAI would most likely be unnecessary.
Your tumor size and location is the best of all possible circumstances. As long as it wasn't considered "multi-focal" your doctor is mostly correct.
As far as I know, current medical practice is that for tumors 10mm or smaller, RAI is given on a case-by-case basis. There are some doctors that would ablate you for this. On one of the listserv support groups I follow, the doctor who moderates has noted cases where there has been spread to lymph glands with "micropapillary" tumors. It does go against "textbook" to see this because one would figure that if you don't see it near the margin, it didn't go past the margin. The doctor never really explain HOW this happens. Maybe he doesn't really know. It could be through the bloodstream or the lymphatic system. The point is--it does happen. I'm not trying to scare you or tell you that your doctor is wrong. I think most doctors will follow what your doctor is doing. But I have noticed that the doctors that are on the cutting edge of thyroid oncology (and there are only a handful in the US) seem to lean toward RAI in all cases.
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My thoughts--in your case I would probably feel very comfortable in NOT getting the RAI. I think the odds are with you that you will be fine. As another poster pointed out, it is very slow growing in most papillary cases and you will be scanned again. Not having RAI does make it wee bit harder to follow you up with bloodwork (tumor marker tests) and scans because you are not fully ablated. Even with a total thyroidectomy, you will still have residual tissue that will take up iodine on a scan (and light up) and you may produce thyroglobulin because you still have cells. You will most likely benefit from regular palpations of the neck and ultrasounds of the neck.
Thank you very much for your comments. I'm not sure it isn't multi focal because of what I'm about to post here now that my pathology report is right in front of me. There are 4 points under "Diagnosis".
"Bilateral near total thyroid resection"
1. papillary carcinoma, lower lobe maximum dimensions 3.5 mm closest margin 1.2 mm
2. residual thyroid with focal adenomatous changes, chronic inflammatory foci, consisten with treated hyperthyroidism.
3. scattered microscopic foci suggestive of incipient papillary carcinoma, not at margins.
4. Hurthle cell adenoma, maximum dimensions 4.8 mm, excised
Since I am new to this whole thyroid cancer idea (about 36 hours now) I'm still reeling and trying to just figure out what all these words mean. Of course, I will be asking many many questions of my endo when I see him on the 18th. I know at some point I'll be scolded for getting my medical information from an internet message board. But, it does give me great comfort "talking" to some people who have been this before. Naturally, every single thing I ask about here will be asked of the doctor as soon as I can.
In terms of the near total, the surgeon did say it was as darn close to total as he could do. He said he almost never "says" he did a total because you can never be sure if you've gotten every thyroid cell. It made sense to me! (and he's the head of oncological surgery at a respected hospital, so I feel like I was in good hands)
Thank you all for any more insight you might provide. I am learning so much from you all.
To the PP who mentioned being sloppy, so to speak, about taking the synthroid early on. I will say that I learned here how important it is to take it carefully. I am getting the brand name stuff and taking it on an empty stomach at the same time each day and then not eating for about another hour.
