eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Thyroid, Papillary Carcinoma, Early: Follow-up

Author: Eric J Lentsch, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina College of Medicine
Coauthor(s): M Boyd Gillespie, MD, MS, FACS, Associate Professor, Department of Otolaryngology, Associate Member of College of Graduate Studies, Medical University of South Carolina; Director, Medical University of South Carolina Snoring Clinics; Surgical Consultant, Medical University of South Carolina Sleep Disorders Center; John C Goddard, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina; Christina ST Wilhoit, EMT, CCRP, Program Coordinator for Head and Neck Surgery Clinical Trials, Department of Otolaryngology, Hollings Cancer Center, Medical University of South Carolina; Zoran Rumboldt, MD, Associate Professor, Department of Radiology, Medical University of South Carolina; Rana S Hoda, MD, FIAC, Professor of Pathology, Attending Pathologist and Director of Cytopathology, University of Rochester Medical Center; Allen O Mitchell, MD, Chairman, Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth; Kenneth M Spicer, MD, PhD, Professor of Radiology with Tenure, Director of Nuclear Medicine Residency, Medical Director of Radiology Informatics, Medical University of South Carolina
Contributor Information and Disclosures

Updated: Apr 24, 2009

Outcome and Prognosis

In general, the prognosis for papillary carcinoma of the thyroid is excellent. A long-term survival rate of approximately 90% exists. One study showed a 1-year survival rate of 97.5%, a 5-year survival rate of 92.8%, a 10-year survival rate of 89.5%, and a 20-year survival rate of 83.9%.

Prognostic factors include tumor size, patient age, extrathyroidal spread, and histological variant. The presence of vascular invasion, even within the thyroid gland, is associated with more aggressive disease at diagnosis and has a higher incidence of tumor recurrence. About 30% of patients develop tumor recurrence. Two thirds of recurrences are within the first decade after therapy. Tumors recur outside of the neck in about 21% of those patients with recurrence. The most common site for distant metastasis is the lung. Mortality rates are lower when recurrences are detected early based on radioiodine scans rather than clinical signs. A long delay in initiating the previously described treatment results in more than 2 times the 30-year cancer mortality rate.

Quality of life and psychosocial issues

Despite the relatively favorable prognosis of papillary thyroid carcinoma, multiple studies have demonstrated that the quality of life among these patients is lower than would be expected, both in the initial year after diagnosis and long term.

Follow-up monitoring for thyroid cancer can have profound effects on patients' lives, as they are required to undergo levothyroxine withdrawal for 4-6 weeks prior to whole-body scanning. This places the patient in the position of trying to maintain normal activity and function while experiencing the well-documented effects of hypothyroidism, including increased fatigue, memory loss, mood disturbances, decreased motor skills, and the many other effects of thyroid dysregulation. The impact of this experience on work performance, family relationships, and social life can be detrimental to the well-being of these patients.

Although the significant effects of levothyroxine withdrawal have been documented for some time, significant deficits in the health-related quality of life and psychometric functionality of patients while on maintenance levothyroxine have recently been reported. Although these deficits are less severe than those experienced during periods of levothyroxine withdrawal, they can be significant, as levothyroxine supplementation therapy typically continues for the remainder of a patient's life.

Future and Controversies

Controversy exists regarding the treatment of papillary thyroid carcinoma. Treatment with total or near-total thyroidectomy results in a higher surgical complication rate, but more conservative measures result in a higher rate of postoperative cancer recurrence. Determination of prognostic factors to classify patients with papillary carcinoma into high- or low-risk categories for mortality after surgery is ongoing. To date, these prognostic factors include age, histologic grade, extrathyroidal invasion, distant metastases, and sex. Classification into high- and low-risk categories can aid in the determination of the most appropriate type of resection.

Much of current clinical research on papillary thyroid carcinoma is focused on finding better methods of detection and better prognostic indicators. Headway is being made in the identification of genetic markers in tumor cells that indicate prognosis in general, as well as in the tendency of the cancer to metastasize. Gene expression patterns have been found that can differentiate between benign thyroid tissue and papillary thyroid carcinomas, as well as between papillary and follicular carcinomas. One example involves the measurement of thyroglobulin concentration in the biopsy tissue obtained from fine-needle aspiration biopsy, which may be useful to determine the involvement of lymph nodes either at initial presentation or in recurrent disease.

Perhaps the most exciting potential for postoperative papillary thyroid patients is the discovery that the administration of rhTSH can stimulate thyroid remnants without causing symptoms of hypothyroidism. At this point in time, rhTSH has been used effectively for the follow-up of thyroid cancer patients and in thyroid remnant ablation, and studies are ongoing to show it’s efficacy in these areas and others.  In the future, patients may be given rhTSH to prepare them for whole-body scanning and to entirely avoid the 4-6 week ordeal of levothyroxine withdrawal.14

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Terry A Day, MD; Michael C Noone, MD; Joshua D Hornig, MD, FRCSC; Jyotika K Fernandes, MBBS, MD; and Anand K Sharma, MBBS, to the development and writing of this article.



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References
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Further Reading

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Keywords

papillary carcinoma, thyroid carcinoma, thyroid carcinomas, papillary carcinomas, thyroid cancer, thyroid neoplasia, thyroid neoplasias, papillary and follicular carcinoma, thyroid tumor, thyroid tumors, diffuse sclerosing variant, Hürthle cell, oxyphilic cell, tall-cell carcinoma, columnar cell carcinoma, thyroid mass, thyroid masses, hemithyroidectomy, near-total thyroidectomy, thyroidectomy, modified radical neck dissection, ipsilateral radical neck dissection, psammoma bodies

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Contributor Information and Disclosures

Author

Eric J Lentsch, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina College of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

M Boyd Gillespie, MD, MS, FACS, Associate Professor, Department of Otolaryngology, Associate Member of College of Graduate Studies, Medical University of South Carolina; Director, Medical University of South Carolina Snoring Clinics; Surgical Consultant, Medical University of South Carolina Sleep Disorders Center
M Boyd Gillespie, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American College of Surgeons, American Head and Neck Society, American Medical Association, Johns Hopkins Medical and Surgical Association, Phi Beta Kappa, and South Carolina Medical Association
Disclosure: Nothing to disclose.

John C Goddard, MD, Staff Physician, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina
John C Goddard, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Christina ST Wilhoit, EMT, CCRP, Program Coordinator for Head and Neck Surgery Clinical Trials, Department of Otolaryngology, Hollings Cancer Center, Medical University of South Carolina
Disclosure: Nothing to disclose.

Zoran Rumboldt, MD, Associate Professor, Department of Radiology, Medical University of South Carolina
Zoran Rumboldt, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Bracco Grant/research funds Other

Rana S Hoda, MD, FIAC, Professor of Pathology, Attending Pathologist and Director of Cytopathology, University of Rochester Medical Center
Rana S Hoda, MD, FIAC is a member of the following medical societies: American Society for Clinical Pathology, American Society of Cytopathology, College of American Pathologists, College of American Pathologists, International Academy of Cytology, South Carolina Medical Association, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Allen O Mitchell, MD, Chairman, Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth
Allen O Mitchell, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Kenneth M Spicer, MD, PhD, Professor of Radiology with Tenure, Director of Nuclear Medicine Residency, Medical Director of Radiology Informatics, Medical University of South Carolina
Kenneth M Spicer, MD, PhD is a member of the following medical societies: American College of Nuclear Medicine, American College of Nuclear Physicians, American College of Radiology, Association of University Radiologists, Radiological Society of North America, Society of Nuclear Medicine, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Medical Editor

David J Terris, MD, FACS, Porubsky Professor and Chairman, Department of Otolaryngology, Medical College of Georgia
David J Terris, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, Federation of American Societies for Experimental Biology, International Association of Endocrine Surgeons, Phi Beta Kappa, Radiation Research Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
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Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
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