CLINICAL-EXPERIENCE IN THE DIAGNOSIS OF 127 PAPILLARY THYROID MICROCARCINOMAS

To investigate the difficulties in the diagnosis of thyroid microcarci noma and to present the results of delaying diagnosis for these patien ts, we retrospectively analyzed the clinical information of 1259 thyro id carcinoma patients in one medical center. During a period of 20 yea rs, from January 1977 to June 1997, 1259 thyroid cancer patients, incl uding 921 papillary thyroid carcinoma patients, who received treatment and were followed-up at Chang Gung Medical Center in Linkou, Taiwan, were evaluated for inclusion in the study. Of these patients, 127 (13. 2%) were diagnosed as having thyroid microcarcinoma. Forty-five patien ts were diagnosed as malignancy or suspicious malignancy preoperativel y with ultrasonography and fine needle aspiration cytological examinat ions. In the analysis, the 127 thyroid microcarcinoma patients who rec eived surgical treatment could be divided into four groups. Group I: p atients with thyroid microcarcinoma with hyperthyroidism or hyperparat hyroidism, in most of whom (except four patients) the thyroid microcar cinoma was found incidentally during the operation (28 cases). Group I I: thyroid microcarcinoma in benign larger thyroid nodule or multinodu lar goiter, or thyroid microcarcinoma in coexistence with nodule goite r in one patient. The thyroid microcarcinomas in this group were found incidentally except in five patients (58 cases). Group III: thyroid m icrocarcinoma which could be detected as thyroid nodule preoperatively (28 cases). Group IV: thyroid microcarcinoma presented with neck lymp h node metastases or distant metastases of the thyroid carcinoma (13 c ases). Median follow-up period of these 127 patients was 4.7 years. Du ring the follow-up period, two patients died, including one patient in group IV who died of skull metastasis with brain invasion. Another pa tient died of stroke, which was, however, not related to thyroid carci noma. in conclusion, most thyroid microcarcinoma patients experienced rather benign clinical courses, but for patients with thyroid microcar cinoma with distant metastases, aggressive surgical treatment followed by radioactive I-131 treatment is indicated.