[Recurrences and metastases in differentiated thyroid cancer]

A total of 201 patients presenting differentiated thyroid gland carcinoma (DTGC), all of them in T1-3Ha-bMo stage, are followed up over a 10-year period, 1980 through 1989. Thyroidectomy with ensuing 131I radiotherapy is used in the treatment of 74 cases, and varying in extent resections--in the remainder. Women up to 50, and men up to 40 years of age (totalling 138 cases) are assigned to low-risk age groups (LRG), and those exceeding the aforementioned age limit (63 cases)--to high-risk age groups (HRG). Local recurrences and lymph node metastases are recorded in 17.5 per cent of the patients undergoing thyroidectomy followed by iodine radiotherapy. Among those subjected to radical resections the rate of recurrences of the lesion amounts to 2.4 per cent. In the HRG the rate of recurrences among thyroidectomized patients is 32 per cent, whereas in those assigned to LRG, treated with organ salvaging operations, the recurrences are 10.1 and 1.1 per cent, respectively. It is established that insofar as recurrences of the lesion are concerned the fifth year remains a high-risk period; by the second year they are increased more than three times. Lymph-node metastases are observed in 80 per cent of the cases by the second year. Local recurrences are more common in HRG--83.3 per cent. As shown by the results of the series reviewed, thyroidectomy followed by 131I radiotherapy fails to improve the prognosis in HRG patients. In these cases better results are attained in those subjected to wide resection of the thyroid gland.