Thyroid cancer in the 1980s--a decade of change

Changes in the 1980s in thyroid cancer included an increased incidence of papillary carcinoma and a decrease in anaplastic carcinoma in the UK; the establishment of cytology as the prime agent in diagnosis; and total thyroidectomy became the operation of choice in many centres and block dissections gave way to local node removal. Thyroxine was shown to give significant improvement in survival. Histological type remained the prime factor in prognosis with papillary carcinoma showing excellent long-term survival rates compared to follicular carcinoma, while anaplastic carcinoma had few survivors over two years (log rank X2 = 304.57, p < 0.005). In the totality of thyroid tumours, excluding consideration of the histology, we found that increasing age, progression of stage T1 and T3 and stage M1 all contributed to reduce survival and that females outlived males. We contrasted technical aspects in total and sub total lobectomy and showed that the more radical procedures reduced local recurrence at the price of increased parathyroid and nerve damage without evidence of improved long-term survival. We found that the critical factor in surgical results was whether the operation cleared all cancer from the neck and suggested near total thyroidectomy as the standard procedure in follicular cell tumours, reserving total thyroidectomy for gross bilateral spread.