title: Outcomes of patients with differentiated thyroid carcinoma following initial therapy.
abstract: This analysis was performed to determine the effect of initial therapy on the outcomes of thyroid cancer patients. The study setting was a prospectively followed multi-institutional registry. Patients were stratified as low risk (stages I and II) or high risk (stages III and IV). Treatments employed included near-total thyroidectomy, administration of radioactive iodine, and thyroid hormone suppression therapy. Outcome measures were overall survival, disease-specific survival, and disease-free survival. Near-total thyroidectomy, radioactive iodine, and aggressive thyroid hormone suppression therapy were each independently associated with longer overall survival in high-risk patients. Near-total thyroidectomy followed by radioactive iodine therapy, and moderate thyroid hormone suppression therapy, both predicted improved overall survival in stage II patients. No treatment modality, including lack of radioactive iodine, was associated with altered survival in stage I patients. Based on our overall survival data, we confirm that near-total thyroidectomy is indicated in high-risk patients. We also conclude that radioactive iodine therapy is beneficial for stage II, III, and IV patients. Importantly, we show for the first time that superior outcomes are associated with aggressive thyroid hormone suppression therapy in high-risk patients, but are achieved with modest suppression in stage II patients. We were unable to show any impact, positive or negative, of specific therapies in stage I patients.
authors.affiliation: Georgetown University Medical Center, Washington, DC 20007, USA. jj@bc.georgetown.edu
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jonklaas
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Sarlis
authors.forename: Danielle
authors.initials: D
authors.lastname: Litofsky
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Ain
authors.forename: S Thomas
authors.initials: ST
authors.lastname: Bigos
authors.forename: James D
authors.initials: JD
authors.lastname: Brierley
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Haugen
authors.forename: Paul W
authors.initials: PW
authors.lastname: Ladenson
authors.forename: James
authors.initials: J
authors.lastname: Magner
authors.forename: Jacob
authors.initials: J
authors.lastname: Robbins
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Ross
authors.forename: Monica
authors.initials: M
authors.lastname: Skarulis
authors.forename: Harry R
authors.initials: HR
authors.lastname: Maxon
authors.forename: Steven I
authors.initials: SI
authors.lastname: Sherman
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000628:therapy; D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D002291:Carcinoma, Papillary / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology / Q000628:therapy*; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes