Papillary and follicular thyroid cancer: selective therapy.

Papillary and follicular thyroid cancers ordinarily have an excellent prognosis and are associated with little or no mortality in the majority of patients. However, in others these tumors may become metastatic or extensively invasive and can result in mortality. Patients over the age of 40 characteristically have a less favorable prognosis, with tumors portending a less favorable outcome and a need for more aggressive therapy. Papillary cancers that are large (greater than 1.5 cm), bilateral, metastatic, or locally invasive, and most follicular cancers should be treated with total or near-total thyroidectomy followed by total ablation of remaining tissue that concentrates 131I. In most instances lymph nodes should be simply excised. Thyroid suppression of TSH should always be done. Survival is usually excellent except when the tumor is locally invasive or is metastatic to a distant site. In these instances mortality is substantially reduced if the tumor concentrates 131I and residual tumor can be completely ablated by 131I.