Dr Patel Visit - 8/3/20

Dr Patel 8/3

BP on machine - 135/79, pulse 55

Got bloodwork at NYU Lab on 8/3/20

There is something there but nodes haven’t changed in size. Same assessment as before

The node in the surgical bed is 0.4cm does not worry him. The new foci could just be that moment in time

Continue to watch the nodes since still only around 1 cm. Same assessment as before

I asked him when he would recommend surgery - he said when more nodes appear, the nodes increase in size and/or my bloodwork comes back disturbing. Same assessment as before

Taking out the nodes in section 3/4 would be “easy” since he takes out the whole section. 1.5 hour surgery and home the same day

The surgical bed is much more significant and risky with little benefit. Since it has nerves, scar tissue and vocal cords. So far the tissue is so tiny that you could do surgery in the bed and miss the node

See Dr Patel in a year - 8/2/21

Get another ultrasound in 6 months end of Jan beginning of Feb 2021

Dr Patel Visit - 2/3/20

Dr Patel Visit 2/3

-Get ultrasound in 6 months

-See him again in Aug 2020 (8/3/20) right after ultrasound (get last week in July 2020)

-Nodes are too small do to FNA

Even though Tg is still non existent, it may not be the best indicator of cancer or presence of thyroid tissue since the nodes are so tiny and would not give off a significant amount of Tg to be picked up in blood test. It is a better indicator of metastasis or new tissue.  Sonogram is more sensitive than blood test and is better for me to rely on.

The new node is in the same area as the others (level 4).  Which at least is a good sign that nodes are not popping up in new areas

If more nodes start to pop up in the level 4 area, it might be time to have them surgically removed - neck dissection along my right side. This is the indicating factor when I asked Dr Patel about when would be the right time for me to move forward with surgery.  1 day procedure.  Home the same day.  Possible RAI afterwards 

He felt my neck and didn’t feel anything. He reviewed the images during visit as well 

Dr Goyal 9/27/19

9/27/19 Dr Goyal

Check blood tests in Jan 2020

Please call NYU radiology 212 263 8868 to schedule your thyroid ultrasound in Jan 2020

Take synthroid 1 tablet Monday-Sat and 2 tablets on Sunday

Appt on 3/27/20. @ 3:30

Found my notes:

No longer recommending a total body scan since blood tests and ultrasounds have been stable.  I have had negative scans over the past 10 years.  Usually take scans for the first five years. 

Ultrasound - take in Jan 2020 before appt with Dr Patel

Bloodwork - take in Jan 2020

Dr Goyal appt - March 2020

Synthroid - dame dosage as before which is 1 pill x 6 and 2 pills x 1

TSH was 0.16

Dr Cocks Physical - 8/2/19

Dr Cocks Physical -8/2

BP was fine- 122/83 on machine and then he took it manually and got the same reading

Got blood test for lipid panel

Cholesterol had upticked on the higher side at 207

Dr Patel - 7-29/19

Dr Patel 7/29

Not worried at all about thyroid bed 

Looked at the sonogram films himself and was not worried

Nodes do looks suspicion but hasn’t changed in size in years 

Doesn’t have a bias either was regarding scan

He is comfortable with just having another ultrasound in 6 months

Do nothing now until I see Goyal in Sept

If she wants scan then go ahead

If anything, Patel would recommend surgery rather than RAI if it comes to that in the future but nothing is needed for the foreseeable future

Dr Patel Appt - May 13 2019

Dr Patel

149/81 BP in the machine

Felt my neck and thyroid and did not feel anything abnormal

Wanted me to get another ultrasound before discussing RAI again

Said to get an ultrasound in July

Made Dr Patel appt for 7/15 at 9:15

4mm is too small for surgery to be an option anyway at this point

If tissue is still there in July, then we can talk options-scan, RAI,biopsy

If tissue is still there, RAI might be better option than surgery anyway since RAI would be more focused and effective since only small ant of tissue to absorb and kill than before

Dr Goyal Appointment - 3/29/19

Saw Dr Goyal on 3/29  (blood tests on 3/14 and thyroid ultrasound on 3/20.  Next appointment on 10/1/19 at 8am
BP was 150/89 on the machine
130/89 taken manually

My TSH is a bit higher than desired (1.45) and Dr G wants to lower it below 1.0.
0.5-1.0 ideal range.
Take 112mcg tablet once per day six days per week and 2 pills once a week. Test my blood before Dr Patel - in 6 weeks

New 0.4cm tissue found in thyroid bed. Not there before. In thyroid bed, not lymph node area like before. She recommends scan (low iodine diet). Too small to biopsy. Ask Dr Patel opinion (seeing him on 5/13..  Even if scan shows cancer, next step would be surgery and Dr Patel usually recommends against it until large enough

My questions going into appointment

TSH was higher than the 0.5 range that Dr Bergman discussed last year. Are you happy with where I am at? Does my Synthroid dosage need to be adjusted?

What is your assessment of my ultrasound results? Are you concerned? The size of the nodes seem to have remained the same...do you agree?

Did you order Thyroglobulin and Thyroglobulin AB blood tests? They did not come in yet but sometimes they take longer. My Tg tests have always been negative and I am anxious to see that they continue.

I see that Thyroid AB was same as previous and Tg was N/A and <0 .5="" br="">
What are next steps? Do you recommend a biopsy? Or just monitor with increased frequency of blood test/ultrasound?