Carcinoma of the Thyroid in Patients Aged 50 or Older*

Abstract

At the Sinai Hospital of Baltimore, carcinoma of the thyroid was studied in 60 patients whose ages ranged from 50 to 79 years (Series AA). Data on the author's Series A (185 patients of various ages) and data from reports in the literature (children or adults of various ages) are used for comparison. Carcinoma of the thyroid is fairly common in the 50+ age group, constituting 32 per cent of the cases in patients of all ages (Series A). In the patients aged 50 or older (Series AA), the ratio of females to males was 5.7:1.0 versus 3.9:1.0 for patients of all ages. The thyroid carcinoma was multifocal in 18 per cent of the elderly patients. It was found incidentally upon physical examination in almost two‐thirds of the cases. Radioiodine tracing was of little help diagnostically. The best criterion for diagnosis is a high index of suspicion on the part of the physician. If thyroid nodules are treated aggressively, carcinoma can be diagnosed earlier. Often a preoperatively palpable nodule is not the one identified microscopically as containing carcinoma. Frozen‐section diagnosis can be misleading; in 46 per cent of Series AA, the frozen section was reported as benign whereas the permanent sections were reported as carcinoma. The treatment of choice is total thyroidectomy followed by radioiodine therapy if any foci of carcinoma are found by postoperative scanning. Prophylactic removal of lymph nodes is of no value. Thyroid substitution therapy should be started as soon as possible after operation. With use of the author's methods, postoperative tetany and vocal cord paralysis can be avoided. The mortality rate for thyroid carcinoma in the 60 patients of the 50+ age group was 25 per cent. Of the 15 deaths secondary to metastases, 7 were from solid or anaplastic, 5 from follicular, and 3 from papillary or mixed papillary carcinoma. Thus the papillary type is not always benign, as described by some authors. Thirty of the 60 patients were traceable five or more years after surgery. Of these, 10 had died from thyroid carcinoma, 1 had died from another cause, and 3 were alive but with metastases; however, 16 were alive and free of thyroid carcinoma.