Outcomes of Patients with Differentiated Thyroid Carcinoma Following Initial Therapy

Johns Hopkins University, Baltimore, Maryland, United States
Thyroid (Impact Factor: 4.49). 01/2007; 16(12):1229-42. DOI: 10.1089/thy.2006.16.1229
Source: PubMed


This analysis was performed to determine the effect of initial therapy on the outcomes of thyroid cancer patients. The study setting was a prospectively followed multi-institutional registry. Patients were stratified as low risk (stages I and II) or high risk (stages III and IV). Treatments employed included near-total thyroidectomy, administration of radioactive iodine, and thyroid hormone suppression therapy. Outcome measures were overall survival, disease-specific survival, and disease-free survival. Near-total thyroidectomy, radioactive iodine, and aggressive thyroid hormone suppression therapy were each independently associated with longer overall survival in high-risk patients. Near-total thyroidectomy followed by radioactive iodine therapy, and moderate thyroid hormone suppression therapy, both predicted improved overall survival in stage II patients. No treatment modality, including lack of radioactive iodine, was associated with altered survival in stage I patients. Based on our overall survival data, we confirm that near-total thyroidectomy is indicated in high-risk patients. We also conclude that radioactive iodine therapy is beneficial for stage II, III, and IV patients. Importantly, we show for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high-risk patients, but are achieved with modest suppression in stage II patients. We were unable to show any impact, positive or negative, of specific therapies in stage I patients.

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    • "It is also supported by the fact that patients who have autoimmune thyroid disorders such as Hashimoto thyroiditis showed an increased risk of thyroid cancer by 2.77 times [8]. THS suppressive therapy is a well-known adjuvant therapy to prevent recurrences in follicular cell derived differentiated thyroid cancer (DTC) patients [9], although further studies on specific mechanisms are still required. "
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    Journal of the Korean Surgical Society 07/2013; 85(1):15-9. DOI:10.4174/jkss.2013.85.1.15 · 0.73 Impact Factor
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    • "This meta-analysis concluded that treatment with high thyroxine doses was effective in decreasing recurrence but it had little importance with regards to the overall survival [35]. Then in 2006, a study stratified the effect of this therapeutic approach and found that this approach had no effect on survival in stage I low-risk patients, but patients staged II, III, and IV did have worse survival when TSH level was maintained more than 3 mU/L [36]. The revised ATA guidelines state that “in patients with persistent disease, the serum TSH should be maintained below 0.1 mU/L indefinitely in the absence of specific contraindications.” "
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    ABSTRACT: Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer.
    Journal of Thyroid Research 12/2012; 2012:512401. DOI:10.1155/2012/512401
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    • "ATA guidelines for patients with differentiated thyroid cancer state that the benefit of radioiodine treatment appears to be restricted to patients with larger tumors (>1.5 cm) or residual disease after surgery. There is no evidence that there is any benefit of radioiodine treatment in lower risk patients (defined by the following criteria: PTMC with no extension beyond the thyroid capsule, unifocal tumor, no aggressive histologic subtypes, no extra thyroidal extension or angioinvasion, no local or distant metastases, complete resection of macroscopic tumor, and no 131 I uptake outside the thyroid bed on the post-therapeutic whole-body scan if 131 I was administered; Jonklaas et al., 2006; Cooper et al., 2009). Instead, the recommendation for radioactive iodine is supported by a study (Sakorafas et al., 2007) that followed 27 of 380 (7.1%) patients diagnosed with incidental PTMC (mean diameter 4.4 mm) following thyroid surgery for benign thyroid disease (20 patients with MNG, six patients with follicular adenoma, and one patient with nodular hyperplasia; Sakorafas et al., 2007). "
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    Frontiers in Endocrinology 02/2012; 3:33. DOI:10.3389/fendo.2012.00033
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