DIFFERENTIATED THYROID-CARCINOMA, 1972-19 92 - FOLLOW-UP, DETECTION OF RECURRENCES AND PROGNOSTIC FACTORS

BACKGROUND: There is no consensus about the treatment and the follow-u p of differentiated thyroid carcinoma (DTC), because in some patients, currently known prognostic factors cannot predict the course of the d isease. The aim of this work has been to review the results of the tre atment of our patients with DTC and io assess the prognostic factors. PATIENTS AND METHODS: We include, retrospectively, 204 patients with D IC (54 males and 150 women) with a men (SD) age of 38 (23) years, atte nding to a terciary university hospital. The follow-up is 9.2 (6) year s (range, 2-22 years). They all underwent near total thyroidectomy, ab lative doses of radioactive iodine ((INa)-I-131) and L-thyroxine to su ppres thyroid stimulating hormone [TSH] levels. At least once a year, a clinical examination, a whole-body scan (WBS) with (INa)-I-131 and s erum thyroglobulin (TK) measurements were performed in hypothyroid sta te. In the statistics, chi(2) test, univariate analysis, Student's t t est, Kaplan-Meier method, Mantel-Cox test and multiple regresion analy sis were employed. RESULTS: The survival rate was 89.05%. Twenty patie nts died of DTC (9.8%) (papillary 8 [6%], follicular(12) [17%]). Surgi cal complications (recurrent nerve palsy or permanent hypoparathyroidi sm) were seen in 5% of the patients. The sensitivity of WBS to detect distant metastases or local (neck) involvement was 71% (initial 100%, late 71%). Tg sensitivity was 85% (initial 95%, late 73%). Factors ass ociated to a poor prognosis were age > 40 years (p < 0.0001), follicul ar carcinoma (p < 0.02) and initial stages III and IV (p < 0.0001). CO NCLUSIONS: The mortality and complications rates in our patients with differentiated tyroid carcinoma validate our management schedule. Tg m easurements are more sensitive than WBS to detect distant or local met astases; however, sensitivity of both techniques was lower in the dete ction of late metastases. Age below 40 years, papillary carcinoma and initial stages I and Is are factors of better prognosis.