Patients with Thyroid Carcinoma Distant Metastasis Are Identified at Initial Treatment

Abstract

Objectives:

Distant metastases (DM) worsen prognosis in patients with well differentiated thyroid carcinoma (WDTC), and. DM can be identified at initial evaluation or follow up. These patients must be followed aggressively and treated appropriately. Our goal was to identify when distant metastases are identified in patients with WDTC and patients’ initial clinical features.

Methods:

Retrospective chart review of patients with WDTC and distant metastasis treated with radioactive iodine at our department.

Results:

Between 1988 and 2009, 73 patients with WDTC and distant metastasis had radioactive iodine at our hospital. Sixty were female; patient ages ranged from 7 to 74 years old (mean 47), 40% under 45 y/o. The lung was the most affected organ (70%); bones (12%); lungs and bones (12%); liver and breast. Tumor diameter was ≤4cm in 74% of the patients (15% ≤1cm) and ≤4cm in 26%. In 48% of patients, the primary tumor histology was a classic papillary thyroid cancer, followed by follicular carcinoma or follicular variant of papillary carcinoma in 41% of the patients and Hurthle cell carcinoma in 3%. Only 8% had poorly differentiated carcinoma. Lymph node metastases were present in 64% of patients, 14% in both central and lateral neck compartments. Distant metastases were present in the first postoperative whole body scan in 90% of the patients.

Conclusions:

The majority of patients with distant metastasis (90%) were identified at initial treatment. Follow up intensity can be reduced in the remaining patients. Clinical features do not prevent complete evaluation of patients with WDTC. Patients with distant metastasis of thyroid cancer had small well differentiated carcinomas and were under 45 years old.