[Therapy of differentiated thyroid carcinomas. Prospective study].

UNLABELLED: During an 11-year period (1973-1984) a consecutive series of papillary (n = 30) and follicular (n = 38) thyroid carcinomas was prospectively selected, on the basis of a clinico-pathologic and prognostic classification, for 1) non-total thyroidectomy (n = 20), 2) total thyroidectomy (n = 13), or 3) total thyroidectomy and radioiodine (n = 35), together with exogenous suppressive thyroxine therapy in most patients. Patients with an occult papillary carcinoma and patients under 40-50 years of age with an intrathyroidal, single papillary carcinoma without nodes, and microangioinvasive follicular carcinoma were often treated by non-total thyroidectomy or without radioiodine. Some patients refused adequately radical therapy (completion of thyroidectomy or radioiodine).

RESULTS: a half-year to 11 (5 +/- 3) years following treatment no recurrences or deaths occurred in occult papillary and in microangioinvasive follicular tumors (treated by total thyroidectomy and radioiodine in 1 of 9 and in 2 of 9 patients respectively); 1 death and 1 curable recurrence occurred in the intrathyroidal papillary carcinoma group (treated by total thyroidectomy and radioiodine in 7 of the 15 patients); 3 patients died and there were 4 recurrences (3 locoregional, 1 systemic) in the patients suffering from extrathyroidal papillary or angioinvasive follicular carcinoma (treated by total thyroidectomy and radioiodine in all of the 6 and in 19 of 29 patients respectively). Patients who died (all had pulmonary metastases at the time of diagnosis) and those with a recurrence had total thyroidectomy with radioiodine as the primary treatment. In lethal papillary carcinomas, large follicular and solid areas, squamous cell metaplasia or anaplastic transformation were observed.(ABSTRACT TRUNCATED AT 250 WORDS)