Author(s): Emerick GT, Duh QY, Siperstein AE
BACKGROUND: There have been numerous studies concerning the diagnosis, treatment, and prognosis of patients with papillary thyroid carcinoma, but relatively few addressing patients with follicular carcinoma. METHODS: The authors analyzed their experience with 65 patients who underwent 96 thyroid operations for pure follicular thyroid carcinoma from 1956 to 1990. RESULTS: The patients were 43 women and 22 men with a mean age of 45 years who were followed postoperatively for a mean of 10.4 years. Fifty-two patients (80%) were seen initially with a solitary thyroid nodule, and 24 (37%) had symptoms at presentation. Median tumor size was 2.2 cm. Fine-needle aspiration biopsy was performed in 20 patients, revealing a follicular neoplasm in 18 patients (90%) and an inadequate specimen in 2 patients. Nineteen patients received thyroid-stimulating hormone (TSH)-suppressive thyroid hormone therapy for an average of 4.5 months before surgery; tumor size remained the same in 10 patients (53%), increased in 5 (26%), and decreased in 2 (11%). At presentation, six patients had lymph node involvement, three had locally invasive tumors, and two had distant metastases. Initial operative treatment was lobectomy in 32 patients (49%), total thyroidectomy in 15 patients (23%), lobectomy plus contralateral partial or subtotal lobectomy in 11 patients (17%), and lesser procedures in 7 patients (11%). Twenty-nine patients had a completion total thyroidectomy, so that final surgical treatment consisted of total thyroidectomy in 44 patients (68%). Among 39 patients having intraoperative frozen section, only 3 (8%) were correctly diagnosed as having cancer. Permanent complications occurred during 3 of the 96 operations. Three patients (5%) have died of thyroid cancer (one with anaplastic transformation) since thyroidectomy, and two are living with distant metastatic disease. CONCLUSIONS: Patients with follicular thyroid cancer, when first examined, usually have solitary thyroid nodules that are follicular neoplasms by aspiration cytology, and these nodules fail to regress in response to TSH-suppressive therapy. Frozen section rarely aids in management. The preferred treatment for follicular neoplasms is lobectomy followed by completion total thyroidectomy for histologically proven carcinomas larger than 1.0 cm. Total thyroidectomy allows use of thyroglobulin and radioiodine scanning to detect and treat metastatic disease. Complications of thyroidectomy were uncommon, and the mortality rate in treated patients was relatively low.