Pure follicular thyroid carcinoma: impact of therapy in 214 patients.

Records of 214 patients with pure follicular thyroid carcinoma were reviewed in detail to evaluate the circumstances of initial presentation and therapy on ultimate outcome. Mean followup was 8.8 yr. The only deaths directly attributable to the thyroid carcinoma occurred in patients with distant metastases at the time of presentation. There were 20 recurrences in the 182 patients considered free of disease after initial therapy. Overall recurrence rate was not affected by the presence of positive cervical nodes or extent of thyroid surgery. Postoperative recurrence rate was decreased by both radioiodine and thyroid-hormone therapy. Extensive histologic invasion of the capsule of the nodule and thyroid appeared to be associated with an increase in recurrence rate. Postoperative thyroid-hormone is required therapy in all patients with pure follicular thyroid carcinoma. Radioiodine therapy is indicated in patients with extensive invasion and we favor its use in all patients.