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Journal of Clinical Endocrinology & Metabolism Vol. 71, No. 2 414-424
doi:10.1210/jcem-71-2-414
Copyright © 1990 by the Endocrine Society.
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*Thyroid Cancer

Natural History, Treatment, and Course of Papillary Thyroid Carcinoma*

LESLIE J. DEGROOT, EDWIN L. KAPLAN, MAUREEN MCCORMICK and FRANCIS H. STRAUS

Thyroid Study Unit, Department of Medicine, University of Chicago Chicago, Illinois 60637

Address all correspondence and requests for reprints to: Leslie J. DeGroot, M.D., Thyroid Study Unit, Box 138, University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637.

We have analyzed the course of papillary thyroid carcinoma in 269 patients managed at the University of Chicago, with an average follow-up period of 12 yr from the time of diagnosis. Patients were categorized by clinical class; I, with intrathyroidal disease; II, with cervical nodal metastases; III, with extrathyroidal invasion; and IV, with distant metastases.Half of the patients had a history of thyroid enlargement known, on the average, for over 3 yr. In 15% of patients given thyroid hormone, the mass decreased in size. The peak incidence of cancer was when subjects were between 20–40 yr of age. Tumors averaged 2.4 cm in size; 21.6% had tumor capsule invasion, and 46% of patients had multifocal tumors. Sixty-six percent of the patients had near-total or total thyroidectomy. The overall incidence of postoperative hypoparathyroidism was 8.4%, but the incidence was zero in 83 near-total or total thyroidectomies carried out by 1 surgeon. Twenty-five percent of the patientshad continuing or recurrent disease, and 8.2% died from cancer. Deaths occurred largely in patients with class III or IV disease. Cervical lymph nodes were associated with increased recurrences, but not increased deaths. Extrathyroidal invasion carried an increased risk of 5.8-fold for death, and distant metastases increased this risk 47-fold. Age over 45 yr at diagnosis increased the risk of death 32-fold. Tumor size over 3 cm increased the risk of death 5.8-fold. Surgical treatment combining lobectomy plus at least contralateral subtotal thyroidectomy was associated, by Cox proportional hazard analysis, with decreased risk of death in patients with tumors larger than 1 cm and decreased risk of recurrence among all patients, including patients in classes I and II, compared to patients who underwent unilateral thyroid surgery or bilateral subtotal resections. By {chi}2 analysis, 131I ablation of residual thyroid tissue after operation was associated with decreased risk of recurrence in tumors larger than 1 cm and decreased risk of death in patients in classes I and II with tumors more than 1 cm in size. The data strongly support the use of more extensive initial surgery in class I and II patients with tumors more than 1 cm in size as well as postoperative radioactive 131I ablation of thyroid remnant tissue.

* This work was supported by USPHS Grants DK-13377 and DK-27384, March of Dimes Grant 1–1166, The Boots Co., the David Wiener Research Fund, and the Nathan and Frances Goldblatt Society for Cancer Research.

Received February 5, 1990.




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Arch Otolaryngol Head Neck SurgHome page
G. W. Randolph
Papillary Carcinoma of the Thyroid: Extent of Thyroidectomy
Arch Otolaryngol Head Neck Surg, April 1, 2001; 127(4): 462 - 463.
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J. Clin. Endocrinol. Metab.Home page
S. Gupta, A. Patel, A. Folstad, C. Fenton, C. A. Dinauer, R. M. Tuttle, R. Conran, and G. L. Francis
Infiltration of Differentiated Thyroid Carcinoma by Proliferating Lymphocytes Is Associated with Improved Disease-Free Survival for Children and Young Adults
J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 1346 - 1354.
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J. Clin. Endocrinol. Metab.Home page
S. A. R. Doi
Usefulness of the Diagnostic Total Body Scan in Differentiated Thyroid Cancer
J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 949 - 949.
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Arch SurgHome page
A. Ohshima, H. Yamashita, S. Noguchi, S. Uchino, S. Watanabe, M. Toda, E. Koike, K. Takatu, and H. Yamashita
Indications for Bilateral Modified Radical Neck Dissection in Patients With Papillary Carcinoma of the Thyroid
Arch Surg, October 1, 2000; 135(10): 1194 - 1198.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
Y. Kitamura, K. Shimizu, S. Tanaka, K. Ito, and M. Emi
Association of Allelic Loss on 1q, 4p, 7q, 9p, 9q, and 16q with Postoperative Death in Papillary Thyroid Carcinoma
Clin. Cancer Res., May 1, 2000; 6(5): 1819 - 1825.
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J. Clin. Endocrinol. Metab.Home page
C. L. Fenton, Y. Lukes, D. Nicholson, C. A. Dinauer, G. L. Francis, and R. M. Tuttle
The ret/PTC Mutations Are Common in Sporadic Papillary Thyroid Carcinoma of Children and Young Adults
J. Clin. Endocrinol. Metab., March 1, 2000; 85(3): 1170 - 1175.
[Abstract] [Full Text]


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Arch Otolaryngol Head Neck SurgHome page
R. E. Gardner, R. M. Tuttle, K. D. Burman, S. Haddady, C. Truman, Y. H. Sparling, L. Wartofsky, R. B. Sessions, and M. D. Ringel
Prognostic Importance of Vascular Invasion in Papillary Thyroid Carcinoma
Arch Otolaryngol Head Neck Surg, March 1, 2000; 126(3): 309 - 312.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
B. R. Haugen, F. Pacini, C. Reiners, M. Schlumberger, P. W. Ladenson, S. I. Sherman, D. S. Cooper, K. E. Graham, L. E. Braverman, M. C. Skarulis, et al.
A Comparison of Recombinant Human Thyrotropin and Thyroid Hormone Withdrawal for the Detection of Thyroid Remnant or Cancer
J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 3877 - 3885.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
Y. Kitamura, K. Shimizu, M. Nagahama, K. Sugino, O. Ozaki, T. Mimura, K. Ito, K. Ito, and S. Tanaka
Immediate Causes of Death in Thyroid Carcinoma: Clinicopathological Analysis of 161 Fatal Cases
J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 4043 - 4049.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
K.-C. Loh, F. S. Greenspan, F. Dong, T. R. Miller, and P. P. B. Yeo
Influence of Lymphocytic Thyroiditis on the Prognostic Outcome of Patients with Papillary Thyroid Carcinoma
J. Clin. Endocrinol. Metab., February 1, 1999; 84(2): 458 - 463.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
M. Schlumberger
Use of Radioactive Iodine in Patients with Papillary and Follicular Thyroid Cancer: Towards A Selective Approach
J. Clin. Endocrinol. Metab., December 1, 1998; 83(12): 4201 - 4203.
[Full Text]


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Arch SurgHome page
H. Yamashita, S. Noguchi, H. Yamashita, N. Murakami, S. Watanabe, S. Uchino, H. Kawamoto, M. Toda, and I. Nakayama
Changing Trends and Prognoses for Patients With Papillary Thyroid Cancer
Arch Surg, October 1, 1998; 133(10): 1058 - 1065.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
J. P. Travagli, A. F. Cailleux, M. Ricard, E. Baudin, B. Caillou, C. Parmentier, and M. Schlumberger
Combination of Radioiodine (131I) and Probe-Guided Surgery for Persistent or Recurrent Thyroid Carcinoma
J. Clin. Endocrinol. Metab., August 1, 1998; 83(8): 2675 - 2680.
[Abstract] [Full Text]


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Arch SurgHome page
L. E. Sanders and B. Cady
Differentiated Thyroid Cancer: Reexamination of Risk Groups and Outcome of Treatment
Arch Surg, April 1, 1998; 133(4): 419 - 425.
[Abstract] [Full Text] [PDF]


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Arch SurgHome page
S. Noguchi, N. Murakami, H. Yamashita, M. Toda, and H. Kawamoto
Papillary Thyroid Carcinoma: Modified Radical Neck Dissection Improves Prognosis
Arch Surg, March 1, 1998; 133(3): 276 - 280.
[Abstract] [Full Text] [PDF]


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Arch SurgHome page
P. R. Kelemen, A. J. Van Herle, and A. E. Giuliano
Sentinel Lymphadenectomy in Thyroid Malignant Neoplasms
Arch Surg, March 1, 1998; 133(3): 288 - 292.
[Abstract] [Full Text] [PDF]


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NEJMHome page
M. J. Schlumberger
Papillary and Follicular Thyroid Carcinoma
N. Engl. J. Med., January 29, 1998; 338(5): 297 - 306.
[Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
K.-C. Loh, F. S. Greenspan, L. Gee, T. R. Miller, and P. P. B. Yeo
Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients
J. Clin. Endocrinol. Metab., November 1, 1997; 82(11): 3553 - 3562.
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J. Thorac. Cardiovasc. Surg.Home page
T. Nishida, K. Nakao, and M. Hamaji
DIFFERENTIATED THYROID CARCINOMA WITH AIRWAY INVASION: INDICATION FOR TRACHEAL RESECTION BASED ON THE EXTENT OF CANCER INVASION
J. Thorac. Cardiovasc. Surg., July 1, 1997; 114(1): 84 - 92.
[Abstract] [Full Text]


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J. Clin. Endocrinol. Metab.Home page
A. Fiumara, A. Belfiore, G. Russo, E. Salomone, G. M. Santonocito, O. Ippolito, R. Vigneri, and P. Gangemi
In Situ Evidence of Neoplastic Cell Phagocytosis by Macrophages in Papillary Thyroid Cancer
J. Clin. Endocrinol. Metab., May 1, 1997; 82(5): 1615 - 1620.
[Abstract] [Full Text] [PDF]


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Arch Pediatr Adolesc MedHome page
C. E. Wallis
Radiological Case of the Month
Arch Pediatr Adolesc Med, April 1, 1997; 151(4): 423 - 424.
[Abstract] [PDF]


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J. Clin. Endocrinol. Metab.Home page
C. H. Emerson and R. Colzani
Epithelial Cell Thyroid Cancer and Thyroid Stimulating Hormone--When Less is More
J. Clin. Endocrinol. Metab., January 1, 1997; 82(1): 9 - 10.
[Full Text] [PDF]


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Arch Intern MedHome page
P. A. Singer, D. S. Cooper, G. H. Daniels, P. W. Ladenson, F. S. Greenspan, E. G. Levy, L. E. Braverman, O. H. Clark, I. R. McDougall, K. V. Ain, et al.
Treatment Guidelines for Patients With Thyroid Nodules and Well-Differentiated Thyroid Cancer
Arch Intern Med, October 28, 1996; 156(19): 2165 - 2172.
[Abstract] [PDF]


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Arch Pediatr Adolesc MedHome page
K. Viswanathan, T. C. Gierlowski, and A. B. Schneider
Childhood Thyroid Cancer: Characteristics and Long-term Outcome in Children Irradiated for Benign Conditions of the Head and Neck
Arch Pediatr Adolesc Med, March 1, 1994; 148(3): 260 - 265.
[Abstract] [PDF]


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Arch Intern MedHome page
E. L. Mazzaferri
Thyroid Cysts: Does Cancer at Pathology Mean Clinical Cancer?-Reply
Arch Intern Med, June 1, 1991; 151(6): 1228 - 1232.
[Abstract] [PDF]




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