title: Survival analysis of 19 patients with toxic thyroid carcinoma.
abstract: Among patients with differentiated thyroid carcinoma (diffTCa), the rare hyperfunctioning or toxic TCa (ToxTCa) was diagnosed when scintigraphic hot thyroid areas were attributable only to diffTCa (diameter >1 cm by pathological examination) and/or total thyroidectomy failed to induce hypothyroidism. Of 924 cases of all TCa (papillary diffTCa 47.3%, follicular diffTCa 44.2%, others 8.5%), 19 had ToxTCa (2.1%, 15 of 19 follicular, 4 of 19 papillary, P = 0.008). These received a more intensive radioiodine therapy (average cumulated (131)I activities 21.8 vs. 15.2 GBq, P < 0.01). Five-year survival rates for ToxTCa (n = 19, 56%) and diffTCa (n = 545, 94.5%) differed [hazard ratio 4.8, 95% confidence interval (CI) 2.8-8.1, P = 0.001]. However, the differences were attenuated by matching ToxTCa and diffTCa (n = 57, 5-yr survival rate 74%) for age, sex, and histopathologic type (hazard ratio 2.1, 95% CI 1.13-3.9, P = 0.02). Correcting statistically for M(1) against M(0) stage distribution resulted in a further reduction of the hazard ratio (hazard ratio 1.8, 95% CI 0.93-3.48, P = 0.08). An M(1) stage is an important prognostic factor in ToxTCa patients. Thus, ToxTCa, treated with higher activities of (131)I, has a survival prognosis close to that of matched diffTCa cases, both groups consisting mainly (79%) of follicular subtypes.
authors.affiliation: Institute of Pathology, Inselspital, University of Bern, CH-3010 Bern, Switzerland. claudine.als@insel.ch
authors.forename: Claudine
authors.initials: C
authors.lastname: Als
authors.forename: Peter
authors.initials: P
authors.lastname: Gedeon
authors.forename: Helmuth
authors.initials: H
authors.lastname: Rösler
authors.forename: Christoph
authors.initials: C
authors.lastname: Minder
authors.forename: Peter
authors.initials: P
authors.lastname: Netzer
authors.forename: Jean A
authors.initials: JA
authors.lastname: Laissue
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology; D013971:Thyrotoxicosis / Q000150:complications / Q000401:mortality*; D013997:Time Factors