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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Available from: David S Cooper
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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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    • "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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