Improving postoperative recurrence rates for carcinoma of the thyroid gland.

Differentiated carcinoma of the thyroid gland is regarded as an indolent disease. However, this notion is dispelled when the population is stratified according to age, gross and microscopic tumoral characteristics and according to the occurrence of local and distant metastases in the early postoperative period. The adverse effect of local and distant recurrences on survival time has been emphasized in multiple series from the United States and Europe. However, the critical question that has yet to be answered is whether or not inadequately treated differentiated carcinomas of the thyroid gland seemingly cured in younger patients will recur as aggressive, malignant tumors when the same patients reach the graying golden years. A provisional answer to this question may indeed be found in the incidence of early postoperative nodal and distant recurrence rates. Some authors have concluded that the extent of operative treatment does not have a major influence on the course of differentiated carcinoma of the thyroid gland. This conclusion prompted the present follow-up study of 250 patients with differentiated carcinoma of the thyroid gland to examine the clinical course and results of therapy. We report a cumulative mortality rate of 2.4 per cent and a recurrence rate of 1.6 per cent, consisting of a 1.2 per cent incidence of cervical nodal recurrence and a distant recurrence rate of 0.4 per cent (one patient), after a median follow-up period of seven years and a mean of six years. Since there were no differences in treatment and outcome in 191 patients we studied who had papillary and 59 who had follicular carcinoma, they were analyzed as a single group for this report. Total thyroidectomy was the minimal treatment of all operable patients. In addition, 21.0 per cent required a modified dissection of the neck and 8.4 per cent of the patients had postoperative radioactive iodine administered to ablate either remnants of normal tissue or previously undetected metastases to cervical nodes or lungs. Potential factors contributing to improved local and distant recurrence rates included early detection of disease, especially in children who had irradiation and who were recalled and screened (34 per cent in this series); the use of needle aspiration cytologic study, leading to earlier diagnosis and treatment; total thyroidectomy, and the effective use of radioactive iodine administered as a single large dose within the first six months after thyroidectomy.