[Prospective therapy study of differentiated thyroid cancer]

During a 15-year period (1973-1988) a consecutive series of papillary (n = 52) and follicular (n = 48) thyroid carcinomas was prospectively selected, on the basis of a clinico-pathologic and prognostic classification, for 1. non-total thyroidectomy, mostly hemithyroidectomy (n = 37), 2. total thyroidectomy (n = 19), or 3. total thyroidectomy and radioiodine (n = 44), together with exogenous suppressive thyroxine therapy in most patients. Patients with an occult or with an intrathyroidal, single papillary carcinoma without nodes, and microangioinvasive follicular carcinoma were often treated by non-total thyroidectomy or without radioiodine. During the follow-up period of 1-15 (7 +/- 4) years 5 recurrences (nodes n = 4, pulmonary n = 2) and 3 deaths occurred. Seven out of the 8 patients (age 58-76 years) had total thyroidectomy and radioiodine as initial treatment of an intrathyroidal papillary (n = 1), an extrathyroidal papillary (n = 3), and of an angioinvasive follicular (n = 4) carcinoma, respectively (no radioiodine in 1 patient). The study confirms that the outcome may be favourable in selected patients following hemithyroidectomy or without radioiodine treatment. Recurrences or death occurred in some biologically unfavourable tumors despite total thyroidectomy and radioiodine; the relatively frequent total thyroidectomy (73% of the patients) and radioiodine (51%) may have contributed to the disease-free course in the remaining patients.