Treatment of differentiated thyroid carcinoma

Between 1968 and 1991, 190 patients (51 men, 139 women), mean age of 46.3 years, underwent surgery because of differentiated thyroid cancers (148 papillary and 42 follicular carcinomas). In 29.5% of the cases a concomitant goiter was histologically demonstrated. These patients were significantly older (mean, 54,7 years) (p < 0.01). The patients who previously received cervical radiotherapy were significantly younger (mean, 29.7 years) (p < 0,01). The analysis of historical and clinical findings failed to identify predictive factors of biological aggressiveness. Hyperthyroidism occurred in 5.7% of patients: this subgroup did not show any difference in clinical behaviour. Occult carcinoma (14.7%) and multifocality (9.4%) were found more frequently in the glands with a pre-existent goiter (p < 0.05), but the clinical significance of these aspects is uncertain. The surgical treatment of choice was total thyroidectomy (135 patients); more conservative procedures were performed only in younger patients with small lesions, without differences in survival. Postoperatively, a permanent recurrent laryngeal nerve injury occurred in 4 patients (2.1%) and 9 patients (4.7%) required a permanent calcium supplementation. Among follow-up patients (91.6%), those who underwent total thyroidectomy were radiometabolically controlled. A poor prognosis was associated with age (> 40 years), advanced pT and stage, pM and symptomatic metastases.