Mayo Day 3 - not what I was expecting...

Summary:
Issue 1:  Thyroid Cancer:  Ultrasound shows suspicious lymph node on the right side, near where cancer was in 1996.  Biopsy scheduled for Nov 5th.  TSH is too high at 1.5...so more Synthroid starting tomorrow a.m.  Tg (Thyroglobulin - used as a tumor marker) has risen from 0.4 in July to 1.2 now.  TSH is higher, so that accounts for some of the rise...but triple is not great so the thought is I may have a recurrance of thyroid cancer in that node that will be biopsied.  If positive for cancer, the treatment will be ethanol ablation.  If not positive, then we are not sure what is causing the rise in Tg and we'll go from there.  I'll also have a new chest CT to look more closely at the lung nodules that are "benign and stable."  But with rising Tg we can't ignore them.  I'll have the lung CT on Nov 6th.
Issue 2:  Parathryoid Hormone.  It's elevated at 95.  My Calcium is also high normal at 10.0 - I've never had it this high.  The opinion of the doctor is that I have Primary Hyperparathryoidism.  This means that one of the four parathryoids (or more than one, but likely just one) has a benign tumor on it.  That tumor is making parathyroid hormone.    With a calcium of 10.0, surgery is not yet indicated - surgery is indicated at a CA of 11.0.  So we'll watch and wait, but the doctor also ordered a scan of the parathryoid glands.  That will be done on Nov. 5th.  I see the Endo again on Nov. 6th at the end of the day to review everything.
Issue 3:  Lump in my arm that appeared three weeks ago.  Local doctor assistant said it was a lipoma.  The endo concurs, so nothing to worry about at all.  So at least some good news.

Details:
Ugh.  I met Bob in the lobby at Mayo and we went up to Endocrinology together and I was seen actually sooner than my appointment was scheduled.  Mayo is an impressive place!  The doctor said he would review each item separately and he started with the thyroid cancer.  The ultrasound showed:  "A slightly prominent lymph node in the right midneck laterally measuring 6 x 10 x 18mm.  No abnormal lymph nodes elsewhere in the neck."  Then the doctor said that my Tg was 1.2.  I was shocked.  It was just 0.4 in March - that's tripled!  The doctor reminded me that my TSH was also higher at 1.5 and a higher TSH will drive Tg up.  He also reminded me that it's a different assay than the one used at U of Iowa and that could account for differences as well.  But he was still concerned about the Tg level - and I was too.  So he said he'd like to biopsy the node and I agreed.  We talked about what we would do next and he said if positive for papillary cancer we'd use ethanol ablation.  How civilized!  At U of Iowa or elsewhere it would likely mean surgery.  I've had two neck surgeries already - would like to avoid more for sure.  Of course the biopsy could be negative and then I'm not sure what happens...

Then he moved onto the subject of my elevated parathryoid hormone.  Given all the test results - Vitamin D, Calcium, Urine Calcium, Phosphorous, Creatinine - he said I likely have primary hyperparathyroidism.  That's what my PCP (primary care physician) supspected...but I could never get Endo number 3 to agree.  I'm so glad to be working with Endo number 4!  I likely have a small benign tumor on one of my four parathryoid glands.  Surgery is indicated whan Calcium rises above 11.0.  So I'm in that "watch and wait" time frame and the doctor believes we have caught the disease early.  Actually it was caught over a year ago in Iowa City but they MISSED IT although I kept saying it was there.  Did I mention I'm glad I'm at Mayo Clinic??  There is a scan of the parathryoid glands that can be done, but it's not typically diagnostic - it's more of a surgeon's tool - used during surgery to find and remove the one parathryoid gland causing issues.  But, it's a "reasonable test" to order and the doctor ordered it.  If we find something, then it helps us decide what to do next.  If we don't find something, we are still watching and waiting...for what, I'm not sure...for it to get worse?  Ugh.

Anyway, that's where things are.  The doctor originally wanted me up here next week, but I asked to not be seen on Monday or Tuesday due to other plans.  Then he leaves for Boston.  So now I'll be seen on November 5th and 6th.  I need to get a game plan together for my 6 Nov class at UNI...I'm sure I'll figure something out.  As for election day - I already voted so no worries there ;-)

I'll update more when I know more.  The journey continues!