A prospective study was done on 93 cases of differentiated
thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here
Papillary carcinoma is more common (76.35%) than follicular
carcinoma.
Papillary carcinoma affected in the younger patients more commonly than the follicular
carcinoma with a mean age of 34.37years (SD=12.81) for
papillary carcinoma and 44.93 years (SD=16.01) for follicular
carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular
carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant
metastasis as risk factors (p<0.01 and p<0.001); but tumour size and
lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long
thyroxine. All high risk cases were treated with total
thyroidectomy with (35.71%) or without (62.86%) different types of
neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong
thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were
vocal cord palsy (5.5%),
hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%),
wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion
thyroidectomy followed by radioiodine ablasion. Regional
lymphatic metastasis was seen in six cases and was treated by different types of
neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular
carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.