EXPERIENCES WITH I-131 IN THE MANAGEMENT OF CARCINOMA OF THE THYROID.

Abstract

The advent of radioioditie and a host of devices for its detection have led to a more precise and enthusiastic attack on thyroid cancer in the past two decades than was possible before. After a review of the recent literature (7–9, 18, 29–31), one is impressed with rather significant differences in attitudes and approaches in the management of these cases. Since the diagnostic management of patients in our laboratory has been rather carefully planned and the therapy somewhat systematically unplanned, the presentation of our experiences may be of value in consideration of the clinical problems of thyroid cancer. Material Our experience is based upon the study of 67 patients from several Cincinnati hospitals observed at the Radioisotope Laboratory of the Cincinnati General Hospital since 1950. All had clinically evident disease. Cases of carcinoma discovered incidentally within fetal adenomas have been excluded. Patients were initially seen because of an undiagnosed mass in the neck either in the thyroid area, lateral to it, or both (15 cases), or because of a desire to define the extent of disease in known thyroid cancer (52 cases). There were 40 females and 27 males in our group; the proportion of females is somewhat lower than in other series (4, 17). The ages of the patients at the time of diagnosis are shown in Table 1: 27 per cent were under twenty years of age and 52 per cent were under forty. The ages of the patients at the time of diagnosis are shown in Table 1: 27 per cent were under twenty years of age and 52 per cent were under forty. Histologically, the tumors were classified in four groups: papillary, mixed papillary-follicular, follicular, and other. This latter category consists mainly of a variety of undifferentiated carcinomas with a multitude of descriptive labels such as anaplastic, scirrhous, small-cell, Hürthle cell, etc. There was one lymphoma apparently originating in and confined to the thyroid gland. Table I shows the frequency of each histological type of tumor in relation to various age groups; in our series, papillary carcinoma of the thyroid gland was for the most part a tumor of the young, while the undifferentiated variety occurred in later years. Four cases which had been classed as thyroid cancer proved on review to be metastases to the thyroid or malignant growth of extrathyroidal origin. A 4 per cent incidence of metastatic involvement of the thyroid gland is reported in several tumor autopsy series (19, 11).