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Aggressive treatment may benefit patients with thyroid cancer that has spread to other tissues at the time of initial diagnosis
The background of the study. A thyroid nodule is the first manifestation of thyroid cancer in most patients, but in a few patients the cancer has already spread to other organs at the time of diagnosis. This study was done to determine the outcome of patients with thyroid cancer whose tumor had spread at the time of diagnosis and the impact of therapy on outcome.
How the study was done. The study subjects were 49 patients with papillary or follicular cancer of the thyroid who had lung, bone, or other distant spread (metastasis) at the time of diagnosis. They constituted 6 percent of all patients with these types of cancer seen during the same time interval. The metastases were detected by clinical examination and radiologic tests, including x-rays, computed tomography, ultrasonography, and iodine-131 (I-131) scans. The patients’ records were reviewed to obtain information about the details of the disease, treatment, follow-up, and outcome.
The results of the study. The 49 patients included 34 women and 15 men (age range, 17 to 90 years). Twenty-five patients (51 percent) had papillary cancer and 24 (49 percent) follicular cancer. The location of the metastases is shown in the Table.
| Table. Sites of Distant Metastases at the Time of Initial Diagnosis in 49 Patients with Thyroid Cancer. | |
| Site of Metastasis | No. (%) |
| Lung only | 22 (45) |
| Bone only | 19 (39) |
| Other single sites (brain, liver) | 2 (4) |
| Multiple (usually lung and bone) | 6 (12) |
Forty patients (82 percent) were treated with total thyroidectomy, 43 (88 percent) with I-131, 39 (80 percent) with external-beam radiation, and 14 (28 percent) by excision of a metastasis (mostly bone). The metastases were I-131-avid in 29 patients (67 percent); 30 patients (70 percent) received multiple doses of I-131.
Twenty-four patients (49 percent) died during a median follow-up period of 3.5 years, of whom 17 (71 percent) died of thyroid carcinoma. Among the 25 patients (51 percent) who survived, only 4 (16 percent) had no evidence of disease at last follow-up. Favorable prognostic factors were young age, lung (vs. bone) metastases, papillary (vs. follicular) cancer, and I-131 avidity.
The conclusions of the study. The prognosis of patients with papillary or follicular cancer who have metastases at the time of initial diagnosis is poor, but may be improved by I-131 therapy.
The original article. Sampson E, Brierley JD, Le LW, Rotstein L, Tsang RW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer 2007;110:1451-6.
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| Thyroid Digest Index | | | November 2007 Thyroid Digest |
