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Objectives: Distant metastases from thyroid cancer are uncommon and have a variable prognosis. We present a series of patients with distant metastases to determine which patients are at risk of developing distant disease and to examine the significant prognostic variables. Study Design: Retrospective chart review of 30 patients with distant metastases compared with 633 controls from the Mount Sinai Thyroid Cancer Database and literature review. Methods: The prevalence of distant metastases was 4.5%, and median follow-up of survivors was 12.7 years. Histologic type was Hurthle cell carcinoma in 3, follicular in 3, papillary in 19, and 5 patients had focal anaplasia either in the primary site or regional metastases. Predictors for distant metastases, locoregional control, and survival were analyzed. Results: Cumulative survival for patients with distant metastases was 49.5% at 10 years and 12.9% at 20 years. Site of metastases was lung in 26, bone in 11 and brain in 1 patient, with 8 patients having multiple sites. The median time to diagnosis of distant metastases was 3 months. Variables that predicted for development of distant disease were male sex, age, size, extrathyroidal extension, regional metastases, and elevated thyroglobulin. Survival in patients without distant disease was significantly better than those with distant metastases (P < .001). Variables that predicted poor outcome in patients with distant metastases on analysis were age greater than 45 years (P = .003) and histologic type of thyroid cancer (P = .009). Conclusion: Although patients with thyroid cancer and distant metastases may live prolonged periods with disease, it does significantly impact on patient survival. Age remains an important variable in both predicting for development of distant metastases and also influences long-term survival in patients with existing distant metastases.

Objectives: Familial non-medullary thyroid cancer (FNMTC) is a newly recognized disease entity and can be distinguished from the more common sporadic non-medullary thyroid cancer. The purpose of this study was to determine some of the potential distinguishing features of FNMTC. Study Design: Retrospective association study and matched-case control study. Methods: Five hundred forty-three cases of well-differentiated follicular origin thyroid cancers were identified and collected in a database. Among this population, 24 cases of FNMTC were identified. A case of FNMTC was defined as a patient with the following two criteria: a well-differentiated follicular origin thyroid cancer and at least one first-degree relative with a well-differentiated epithelial origin thyroid cancer. The unmatched sporadic and FNMTC groups were compared using t test, Phi test, Cramer V test, and Pearson and Spearman correlation tests. Twenty-four FNMTC cases were matched to 24 sporadic cases based on age, gender, stage of disease at presentation, and tumor size. Clinicopathologic features, management, and outcome were analyzed statistically using a matched-proportional z test. Disease-free survival and disease-specific survival were analyzed using log-rank test and the Kaplan-Meier function. A P-value less than .05 was considered statistically significant. Results: There was no significant difference in ionizing radiation exposure, disease multifocality, surgical management, or recurrence between the sporadic and FNMTC patients. Although FNMTC patients tend to have improved disease-free survival and disease-specific survival, the difference was not significant at the 5% level. Conclusion: Although FNMTC is characterized by strong family history, these patients do not tend to have worse prognosis.

Objectives/Hypothesis: The objective was to compare the rate and site of recurrences in patients with well-differentiated thyroid carcinoma who underwent a central compartment dissection, a posterolateral neck dissection, or a combination of both procedures. Study Design: Retrospective chart review. Methods: The charts of 522 consecutive patients with well-differentiated thyroid carcinoma were reviewed, and 74 patients who had undergone a neck dissection were identified. The rates of recurrence in three sites were noted: the central compartment nodes (levels VI, superior mediastinum), posterolateral compartment neck nodes (levels II-V), and distant sites. These rates were compared in patients who underwent a central compartment dissection (level VI, superior mediastinum) and in patients who underwent a posterolateral neck dissection (levels II-V). Results: Six patients underwent only a central compartment dissection, 47 patients had only a posterolateral neck dissection, and 21 patients had both a central compartment and a posterolateral neck dissection. In these three groups there were zero, two, and two central compartment node recurrences; two, nine, and seven posterolateral neck recurrences; and zero, two, and three distant recurrences, respectively. There were no significant differences in the rate of recurrence in any of the three sites examined between any of the three treatment groups (Fisher's Exact test, all P values > .20). Conclusion: In patients with well-differentiated thyroid carcinoma, dissection of only the central or posterolateral compartments of the neck with clinical or radiographic evidence of disease is advocated.

Objective: To determine the relationship between stimulated serum thyroglobulin levels (taken 3 months after total thyroidectomy) and tumor stage and recurrence in patients with well-differentiated thyroid carcinoma. Study Design: Retrospective chart review in a tertiary care institution. Methods: Two hundred thirteen consecutive patients with well differentiated thyroid carcinoma treated between 1983 and 1998 were identified. Data were collected on clinicopathological variables, stimulated serum thyroglobulin levels obtained 3 months after total thyroidectomy prior to 131 I therapy and recurrence. Results: A high postoperative thyroglobulin level was significantly associated with advanced-stage disease at presentation (P = .005, Kruskall-Wallis) but not with any of the other clinicopathological variables. Patients with a thyroglobulin level greater than 20 pmol/L had a significantly increased risk of disease recurrence on univariate analysis (n = 213 [P = .0001, log rank test]), and in the Cox proportional-hazards model, both advanced tumor stage (P = .001, relative hazard, 3.4 [95% confidence interval [CI]: 2.4-4.9]) and a thyroglobulin level greater than 20 pmol/L (P = .001, relative hazard, 5.1 [95% CI: 2.0-13.1]) were significant predictors of recurrence. No other variables significantly altered the hazards model. Conclusions: Advanced tumor stage at diagnosis and a stimulated thyroglobulin level greater than 20 pmol/L taken 3 months after total thyroidectomy were independent predictors of disease recurrence. Patients with a thyroglobulin level greater than 20 pmol/L are at increased risk of recurrence and may be candidates for more intensive follow-up or additional treatment.