Differentiated thyroid carcinoma in the elderly

The overall prognosis of patients with differentiated thyroid cancer is exc ellent, but the prognosis is rapidly worsening, when the disease is diagnos ed in elderly patients. Old patients more often present with poor prognosti c features, such as large tumors, follicular or Hurthle cell subtypes. extr athyroidal growth and distant metastases. Therefore, an optimal therapeutic approach is recommended. Current therapy includes a total thyroidectomy, i f necessary combined with a lymph node dissection and followed by high dose radioiodine ablation. Radioiodine therapy in elderly patients meets specif ic problems, concerning thyroid hormone withdrawal, side effects of I-131 a nd nursing problems. Additional treatment of residual, recurrent or metasta tic disease must be tailored, according to the stage of the disease, and sh ould not be denied on the basis of chronological age. Lifelong treatment wi th suppressive thyroid hormone therapy does not lead to important long-term side effects at old age. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.