A retrospective analysis of clinical and pathological data was conducted on 706 patients (514 females and 192 males) treated for differentiated thyroid carcinoma at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1951 to 1975 and followed to 1981. The histological diagnoses were mixed papillary/follicular carcinoma (66.7%), papillary carcinoma (14.6%), follicular carcinoma (15.3%), or Hurthle cell carcinoma (3.4%). Patients diagnosed before the age of 40 yr lived significantly longer than those diagnosed over the age of 40 yr, and females lived longer than males. According to survival analyses and disease-free intervals, the order of increasing aggressiveness of the tumors was papillary, mixed, follicular, and Hurthle cell. Total thyroidectomy was associated with longer disease-free intervals and fewer recurrences. The 136 patients who received ablative 131I after surgery had fewer recurrences than a matched group who did not, but the disease-free interval and survival rate showed no significant difference. Further classification showed that patients with follicular and mixed tumors, and those who underwent total thyroidectomy benefited from 131I. There were 78 deaths attributed to thyroid cancer in the whole group. Approximately two thirds occurred in the first 10 yr after diagnosis. In conclusion, total thyroidectomy is recommended, when feasible, for differentiated thyroid cancer, followed by ablative 131I therapy, at least for follicular and mixed varieties.
Thyroid carcinoma was found unexpectedly in the thyroid gland or lymph nodes, at autopsy or in the surgical material removed from 22 patients with carcinoma of the head or neck region, or of the lung. Of 120 patients who had wide‐field laryngectomy for squamous carcinoma of the head or neck, 6 (5%) had carcinoma in the portion of the thyroid gland removed at laryngectomy. Twenty of the 22 patients had mixed papillary and follicular or pure follicular thyroid carcinoma in the thyroid gland or lymph nodes and 2 had the solid type with amyloid stroma. Carcinoma was demonstrated in the thyroid glands of 15 of the 22 patients. Only a portion of the gland or none at all was removed from the other 7 patients and no primary carcinoma was demonstrated. Carcinoma was discovered, however, in every case in which the whole thyroid gland was available for study. Histologically, the metastases of mixed papillary and follicular carcinoma varied from predominantly papillary to predominantly follicular. The smaller the metastases, the more prominent were the follicles and the more normal was their appearance. From our observations, we believe that any thyroid tissue found in a lymph node represents metastatic thyroid cancer.
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