Outcomes of Patients with Differentiated Thyroid Carcinoma Following Initial Therapy

Abstract

This analysis was performed to determine the effect of initial therapy on the outcomes of thyroid cancer patients. The study setting was a prospectively followed multi-institutional registry. Patients were stratified as low risk (stages I and II) or high risk (stages III and IV). Treatments employed included near-total thyroidectomy, administration of radioactive iodine, and thyroid hormone suppression therapy. Outcome measures were overall survival, disease-specific survival, and disease-free survival. Near-total thyroidectomy, radioactive iodine, and aggressive thyroid hormone suppression therapy were each independently associated with longer overall survival in high-risk patients. Near-total thyroidectomy followed by radioactive iodine therapy, and moderate thyroid hormone suppression therapy, both predicted improved overall survival in stage II patients. No treatment modality, including lack of radioactive iodine, was associated with altered survival in stage I patients. Based on our overall survival data, we confirm that near-total thyroidectomy is indicated in high-risk patients. We also conclude that radioactive iodine therapy is beneficial for stage II, III, and IV patients. Importantly, we show for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high-risk patients, but are achieved with modest suppression in stage II patients. We were unable to show any impact, positive or negative, of specific therapies in stage I patients.

Endogenous Thyrotropin and Triiodothyronine Concentrations in Individuals with Thyroid Cancer

“…More recent data from a prospectively followed, but nonrandomized cohort of patients with thyroid cancer has shown improved overall and disease-specific survival with TSH suppression in those stratified as having high-risk disease (13). Furthermore, suppression of TSH to an undetectable limit was associated with the greatest benefit.…”

Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma

“…In this study no further datasmall carcinomas, presumably for lack of events. Another study by the National Cooperative Thyroid Cancer Treatment Study Group demonstrated a beneficial effect of radioiodine therapy in all patients except those with stage I disease [17]. Unfortunately, group I in this study consisted of a large sample of young patients with the disease extent varying from microcarcinomas to microscopic extraglandular invasion or cervical lymph node metastases.…”

2016 Russian clinical practice guidelines for differentiated thyroid cancer diagnosis and treatment

“…Препаратом выбора является лево-тироксин [1, 2, [138][139][140][141][142][143][144][145][146][147][148][149][150][151][152].…”