Crile G, Antunez A R, Esselstyn C B, Hawk W A, Skillern P G
Cancer. 1985 Jun 1;55(11):2691-7. doi: 10.1002/1097-0142(19850601)55:11<2691::aid-cncr2820551126>3.0.co;2-y.
Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (131I). Moreover, distant metastases can be treated by either 131I or suppression as effectively after they are apparent on x-ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients older than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, 131I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by 131I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.
年龄在6至45岁之间、患有甲状腺乳头状癌远处转移的患者，接受甲状腺次全切除术及甲状腺激素抑制剂量治疗的效果与接受甲状腺全切除术并继以131碘（131I）治疗相同。此外，远处转移在X线显影后，采用131I或抑制治疗的效果与在亚临床阶段治疗时相同。因此，对于年龄小于45岁的患者，很少需要进行甲状腺全切除术或频繁的术后扫描。对于年龄大于44岁或小于7岁、有远处转移或两叶广泛受累的患者，如果能将手术 morbidity降至最低，则进行甲状腺全切除术或几乎全切除术是合理的。对于这个年龄组中肿瘤对甲状腺激素抑制剂量无反应的患者，应使用131I。鉴于诊断相关组（DRG）对医院经济的重要性，我们注意到甲状腺全切除术、131I消融术和间歇性全身扫描的费用至少是较保守手术的三倍，而较保守手术结合甲状腺激素补充治疗，能在降低 morbidity的情况下获得相同的生存率。
