William M. McConahey

Papillary Thyroid Cancer Treated at the Mayo Clinic, 1946 Through 1970: Initial Manifestations, Pathologic Findings, Therapy, and Outcome

We performed a retrospective study of 859 patients with papillary thyroid cancer, who had received their primary treatment at the Mayo Clinic during the period 1946 through 1970. The maximal follow-up was 39 years. All but 2 patients underwent a thyroid operation; 319 (37%) had metastatic cervical nodes. Of the 800 patients without distant metastatic lesions on initial examination who underwent a potentially curative surgical procedure, postoperatively 7% had nodal metastatic lesions, 6% had a local tumor recurrence, and 5% had a distant metastatic lesion. In patients who had intrathyroidal tumors initially, postoperative local recurrences or distant metastatic lesions resulted in a 10-year cancer mortality of 17 and 41%, respectively; in those with extrathyroidal tumors, postoperative recurrences were associated with significantly higher death rates. Death from thyroid cancer was highly associated with the following factors: age more than 50 years, male sex, tumor size, tumor grade, initial extent of disease, and absence of Hashimotos disease. Earlier studies of Mayo patients treated between 1926 and 1960 described no deaths due to thyroid cancer in patients with occult tumors (1.5 cm or less). Four such patients were identified among our 859 patients; all had been examined and treated after 1961. To date, 56 (6.5%) of the 859 patients have died as a result of papillary thyroid cancer. In this study, in which 16% of patients underwent total thyroidectomy and 3% had radioiodine ablation, the overall mortality observed at 30 years was only 3% above that expected.

Anaplastic Carcinoma of the Thyroid: A Clinicopathologic Study of 82 Cases

Anaplastic carcinoma of the thyroid accounts for about 10% to 15% of all thyroid carcinomas in the United States. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival of 4 months. Rapid growth of a thyroid mass, frequently in a preexisting goiter, is the most common manifestation; the diagnosis should be considered and expeditiously pursued in all patients who present with this finding. Relatively favorable prognostic features seem to be unilateral tumors, a tumor diameter of less than 5 cm, no invasion of adjacent tissue, and absence of nodal involvement. For resectable lesions, thyroid lobectomy with wide margins of adjacent soft tissue on the side of the tumor seems to constitute a safe, appropriately aggressive surgical approach. Total thyroidectomy and radical neck dissection results in an increased complication rate and has no advantage over a more conservative approach. Radiotherapy, chemotherapy, immunotherapy, and combination radiotherapy and chemotherapy need further evaluation.

Invasive Hürthle cell carcinoma of the thyroid: natural history and management

Debate surrounds the natural history and appropriate management of Hürthle cell neoplasms of the thyroid. Some of the uncertainty stems from difficulty in the differentiation of benign from malignant lesions. We report the presentation, management, and outcome of patients with invasive Hürthle cell carcinoma who were examined at this institution between 1946 and 1971. We believe that our review allows us to make reasonable recommendations concerning the management of patients with this type of carcinoma.

Medullary Thyroid Carcinoma: Clinicopathologic Features and Long-Term Follow-Up of 65 Patients Treated During 1946 Through 1970

We retrospectively reviewed the medical records of 65 consecutive patients with medullary thyroid carcinoma, who had had their primary surgical treatment at the Mayo Clinic during the years 1946 through 1970. Of these patients, 58 had sporadic and 7 had familial medullary thyroid carcinoma. Thyroid nodules were the most common initial manifestation. Near-total thyroidectomy was the most frequent initial operation. Survival was affected by the following factors: male sex, familial inheritance, size of the tumor, stage of the tumor (American Joint Committee on Cancer), and completeness of initial resection of the tumor. The mean duration of follow-up was 23.5 years, and the maximal follow-up was 36 years. Among 52 patients without initial distant metastatic involvement and with complete resection of the tumor, 20-year survival free of distant metastatic lesions was 81%. Overall 10- and 20-year survival rates were 63% and 44%, respectively. Because of the substantial morbidity and mortality associated with medullary thyroid carcinoma, early diagnosis and thorough initial resection of the tumor are important.

Mortality from papillary thyroid carcinoma. A case-control study of 56 lethal cases.

To document the presentation, findings, therapy, and postoperative course of lethal papillary thyroid carcinoma (PTC), 56 fatal cases were studied in a retrospective case‐matched control fashion. These patients and their controls were taken from a larger series receiving their primary treatment at one institution (Mayo Clinic; 1946–1970). Mean follow‐up for the lethal cohort was 8.5 years and 16.6 years for controls. Age, sex, tumor size, histologic grade, extent of disease at presentation, European Organization for Research on Treatment of Cancer (EORTC) and AGES scores (patients age, tumor grade, tumor extent, and tumor size), and DNA ploidy pattern were found to be significant prognostic factors. The immediate causes of death were most frequently either local airway obstruction or respiratory insufficiency from pulmonary metastases. The results suggest that it is possible, at the time of initial treatment, to assess an individual patients risk of dying from PTC. Aggressive postoperative adjunctive therapy should be restricted to that minority of patients who are at highest risk of death from PTC.

Adrenocorticosteroid therapy in pregnancy

Abstract We have reviewed the course of events respecting 21 patients who received cortisone or cortisone-like compounds during 29 pregnancies. In 17 pregnancies, the patients were taking the corticosteroids at the time of conception. Lengths of gestation and birth weights were considered to be within normal limits. No cases of fetal adrenocortical insufficiency were noted. Several minor fetal abnormalities were not considered to be related to maternal steroid therapy. Included in this series were cases in which large doses of adrenocorticosteroids were used both at the time of conception and throughout the entire pregnancy for a variety of indications. This therapy did not appear to have an untoward effect on the infant. For protection during labor or cesarean section, it is important to give adequate parenteral injections of adrenocorticosteroids to all pregnant patients whose adrenocortical function may have been suppressed by therapy with glucocorticoids.

Hashimoto's Thyroiditis: An Uncommon Cause of Painful Thyroid Unresponsive to Corticosteroid Therapy

The records of eight patients with thyroid tenderness secondary to Hashimotos thyroiditis were reviewed. The pathologic characteristics of thyroid tissue sections from these patients were compared with those from patients with nontender Hashimotos thyroiditis, and no difference was identified. Laboratory features helpful in distinguishing tender Hashimotos thyroiditis from subacute (de Quervains) thyroiditis include normal erythrocyte sedimentation rate, significant 131I uptake, and significant antithyroid antibody titer. Diagnosis should be confirmed by fine-needle aspiration biopsy. Corticosteroid therapy was unsuccessful in treating these patients; L-thyroxine and aspirin were successful more often. Two patients required thyroidectomy to control pain.

Significance of Morphologic Thyroiditis

Excerpt Since the possible auto-immune nature of Hashimotos thyroiditis was elucidated (1), association of this phenomenon with other diseases that also might be auto-immune in nature has been obs...

Radiation and Thyroid Neoplasia

Excerpt To the editor: It is now generally accepted that an association exists between external radiation administered to the head, neck, and upper thorax of infants, children, and adolescents and ...

Serum creatine kinase as a test of thyroid function.

Excerpt In a recent French paper, Itelson, Rubinstein, Gaist, and Menache (1) reemphasize the previously reported information (2-4) that creatine kinase activity in serum is above normal in patient...