title: Managing patients with papillary thyroid carcinoma: insights gained from the Mayo Clinic's experience of treating 2,512 consecutive patients during 1940 through 2000.
abstract: 2,512 consecutive patients with papillary thyroid carcinoma (PTC) were managed during 1940 through 2000 at the Mayo Clinic. During that period, there were two significant therapeutic trends. The first was a change in surgical practice during 1940-69 from an initial unilateral lobectomy (UL) to a bilateral lobar resection (BLR). The second was the increasing use since 1970 of I-131 for radioactive-iodine remnant ablation (RRA). The advent of BLR resulted in significantly improved tumor recurrence (TR) rates in both low-risk (MACIS scores < 6) and high-risk (MACIS scores 6+) patients, and also reduced cause-specific mortality (CSM) in high-risk patients. By contrast, RRA did not significantly improve the outcome (either CSM or TR) in low-risk (MACIS < 6) patients previously treated with initial near-total or total thyroidectomy. These data encourage a more selective use of I-131 in PTC management and do not lend support to the current widespread use of RRA in low-risk PTC.
authors.affiliation: Division of Endocrinology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. hay.ian@mayo.edu
authors.forename: Ian D
authors.initials: ID
authors.lastname: Hay
authors.forename: William M
authors.initials: WM
authors.lastname: McConahey
authors.forename: John R
authors.initials: JR
authors.lastname: Goellner
mesh_terms: D002291:Carcinoma, Papillary / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008910:Minnesota; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D013965:Thyroidectomy / Q000639:trends; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes