OUTCOME OF DIFFERENTIATED THYROID-CANCER IN GRAVES PATIENTS

The clinical behavior and outcome was evaluated in 21 nonoccult differ entiated thyroid carcinomas occurring in Graves' patients during the p eriod 1982-94 and compared with that of matched tumors occurring in eu thyroid controls (n = 70). At surgery, patients with Graves' disease s howed distant metastases more frequently than euthyroid patients (3/21 = 14.3% vs. 1/70 = 1.4%, P = 0.0556). Graves' patients also showed a significantly higher cumulative risk of recurrent/progressive distant metastases or total adverse events (odd ratios = 3.14 and 2.07, respec tively) as compared with euthyroid patients. At the last follow-up vis it, persistence of distant metastases was also more frequent in the Gr aves' group (P = 0.007), although the cumulative individual dose of ra dioiodine administered was higher than in the control group (median do se = 805 mCi vs. 350 mCi). Two patients died in the Graves' group vs. none in the control group. Circulating thyroid stimulating antibodies were present in all patients but one and persisted as long as signs of disease were evident. These findings indicate that differentiated thy roid carcinomas in patients with Graves' disease are more aggressive t han those occurring in matched euthyroid controls and should, therefor e, be managed accordingly.