[Long term follow up of medical treatment of differentiated thyroid cancer].
106 patients, 114 W, 27 M, were thyroidectomized for differentiated thyroid cancer (follicular 29.3%-papillary 54.3%) with different stages of gravity (NO: 48.2% - N1: 32.8% - N2: 19%). Neck dissection was used in cases of involved nodes. One or several doses of 131 I were given to 126 subjects, 106 patients were treated with LT4 (mean daily dose: 2.5 micrograms/kg BW). 23 patients presenting intolerance to LT4 with non suppressed TSH for 13 of them were treated by an association of TRIAC + LT4. The follow up included a yearly check up involving clinical examination, plasma Tg and TSH assessment, neck ultrasonography and X-ray of the chest. Therapy was stopped for 4 weeks in cases with Tg above its detectable value and a total body scan performed with Tg and TSH controls. The mean duration of follow up was 94.5 +/- 67.7 months and extended to more than 5 years for 61% of the patients. We observed 22 relapses of the tumor with 4 deaths. Age less then 45 years, appears as the best factor of prognosis. 2 groups of patients were compared to evaluate the incidence of TSH suppression on the relapse free survival (group 1 n = 30 with a TSH < or = 0.10 mU/l and group 2 n = 15 with a TSH always > 1 mU/l during the follow up). The relapse free survival was shorter in group 2 (p = 0.01). Association of TRIAC with LT4 leads to a reduction of the daily dose of LT4 (m = 25 micrograms/day) with a significant improvement of TSH suppression and clinical tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)
Jaffiol
C
C
Service d'Endocrinologie, C.H.U. Montpellier.
Daures
J P
JP
Nsakala
N
N
Guerenova
J
J
Baldet
L
L
Pujol
P
P
Vannereau
D
D
Bringer
J
J
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000601:surgery; D013965:Thyroidectomy; D013974:Thyroxine / Q000008:administration & dosage / Q000627:therapeutic use; D014284:Triiodothyronine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
D014284:Triiodothyronine; C010642:3,3',5-triiodothyroacetic acid; D013974:Thyroxine
Contrôle à long terme du traitement médical du cancer thyroïdien différencié.