Thyroid Research Thyroid Research Archive Thyroid Cancer

Differentiated thyroid carcinoma can grow rapidly in older patients

(July 2003)

The background of the study. Most patients with differentiated thyroid carcinoma are relatively young, but older patients may be affected. This study was done to define the clinical characteristics and course of this tumor in older patients.

How the study was done. The study group was 111 patients with differentiated thyroid carcinoma who were ≥70 years old and who were followed for two or more years after initial therapy. They constituted 8 percent of all patients with differentiated thyroid carcinoma seen at one center since 1949. The patients' records were reviewed for information about presentation, pathologic findings, therapy, and outcome.

The results of the study. There were 83 women and 28 men; the median age was 75 years. The initial sign of the tumor was a thyroid nodule in 89 patients (80 percent), enlarged cervical lymph nodes in 17 patients (15 percent), and bone pain in 6 patients (5 percent). Fifty-eight patients (52 percent) had a papillary carcinoma, 46 (41 percent) a follicular carcinoma, and 7 (6 percent) a Hurthle-cell carcinoma. Treatment consisted of total thyroidectomy in 46 patients (41 percent), partial thyroidectomy in 36 patients (33 percent), and biopsy in 29 patients (26 percent). Subsequently, 20 percent received a single dose of radioactive iodine (I-131), and 52 percent received multiple doses. Twenty-two percent were treated with radiation for local recurrence or palliation of pain from bone metastases.

During a median follow-up period of 9 years, 21 percent of the patients had a local recurrence and 15 percent had distant metastases. The overall survival rates were approximately 50 percent at 5 years and 25 percent at 10 years, and the tumor-related survival rates were 75 percent, 50 percent, and 50 percent at 5, 10, and 15 years, respectively. Older age (≥80 years), lymph node metastases, and external-beam radiotherapy were associated with a low tumor-related survival rate, and follicular-cell histology and total thyroidectomy with a high tumor-related survival rate.

The conclusions of the study. Among older patients, differentiated thyroid carcinomas can be aggressive.

The original article. Vini L, Hyer SL, Marshall J, A'Hern R, Harmer C. Long-term results in elderly patients with differentiated thyroid carcinoma. Cancer 2003;97:2736-42.