Differentiated thyroid cancer in a Swedish county – long-term results and quality of life

Abstract

Background. There is still no complete agreement about the proper treatment of differentiated thyroid cancer (DTC). Material and methods. All patients (nϭ130) with DTC in a defi ned population, treated with surgery between 1985 and 1999, were carefully followed up (median 13.1 years). Fifty three were operated with subtotal and 77 with total thyroidectomy. Twenty seven percent of the patients in the subtotal group and 56% of those in the total thyroidectomy group had postoperative radioiodine ablation. Thirty nine patients had papillary cancers incidentally detected during surgery for benign disorders (median size 7 (1-30) mm). Living patients answered the Swedish version of the SF-36 health survey. Results. Eleven of 106 patients considered tumour-free after primary surgery developed recurrences during follow-up. Fifteen patients (12%) died from DTC but only one within stage I-II (1.2%). No patient below 50 years of age at diagnosis died from DTC. Only three of 29 patients with isolated loco-regional spreading of their disease at the time of diagnosis have died from thyroid cancer. There was no statistically signifi cant difference in the 10 year cancer-specifi c survival rate between those operated with subtotal or total thyroidectomy -irrespective of stage. Survival rate was signifi cantly better for papillary than for follicular cancer. Mental and physical quality of life among patients treated for DTC were similar to the healthy Swedish population. Conclusions. Patients with DTC stage I-II (according to TNM) or low-risk (according to AMES) have an excellent prognosis. Treatment as well as follow-up should not be exaggerated.

Quality of life is not influenced by the extent of surgery in patients with benign goiter

“…To our knowledge, this is the first study to compare the HRQoL after hemithyroidectomy, Dunhill operation, and thyroidectomy for benign thyroid disease. Our findings are consistent with the maintenance of quality of life described after surgical resection of thyroid carcinomas where, in general, the QoL of those patients did not differ to the normal population [19][20][21][22][23][24][25]. The QoL after surgery for WDTC is better than in patients who received radioactive iodine therapy, suggesting that the surgery has a more positive impact than some therapeutic alternatives [26].…”

Radioactive Iodine Therapy Decreases Recurrence in Thyroid Papillary Microcarcinoma

“…I-131 toxicity is dose dependent; patients receiving higher activities of I-131 (>150 mCi) experience increased toxicity [34]. However, despite these toxicities, the long-term quality of life of patients treated for differentiated thyroid cancer has been demonstrated to be similar to that of the normal population [35]. …”

Psychosocial Factors in Patients with Thyroid Disease

“…Impaired health status and quality of life have been surveyed in them (Hoftijzer et al, 2008;Lee et al, 2010). Quality-of-life and health status parameters were inversely affected by duration of cure and consequently may be restored after prolonged follow-up (Giusti et al, 2011;Gómez et al, 2010;Hoftijzer et al, 2008;Malterling et al, 2010;Pelttari et al, 2009). Special attention should be paid in patients with more severe staging on diagnosis (Almeida et al, 2009;Giusti et al, 2011).…”