Seven hundred sixty-one patients with operable differentiated
thyroid carcinoma were treated between 1931 and 1970. Median follow-up time was 18 years and ranged from 5 to 40 years. Sixty-three percent of the patients were followed more than 15 years, and 46% were followed more than 20 years. Because resections usually spared sufficient thyroid tissue for homeostasis,
thyroid hormone was not routinely prescribed after operations performed before 1960. Altogether 244 patients with
papillary carcinoma and 76 patients with follicular
carcinoma received
thyroid hormone, while 296 patients with
papillary carcinoma and 45 patients with follicular
carcinoma did not receive
thyroid hormone after operation. With
papillary carcinoma, 14% of men greater than 40 and women greater than 50 years of age (high risk) but only 2% of men less than or equal to 40 years of age and women less than or equal to 50 years of age (low risk) died of disease (P 0.0001). Twenty-six percent of high-risk but only 4% of patients with low-risk follicular
cancer died (P 0.0001). However, there was no statistically significant improvement in survival times with use of
thyroid hormone when patients were categorized by risk group and pathology. These data support the importance of age and sex in previously described risk groups; these factors supersede the effects of adjuvant treatment. This absence of effect on survival times calls into question current recommendations for routine use of
thyroid hormone after surgical
therapy. Conceptually, such absence of adjunctive
hormone effect on survival time after operation is similar to hormonal effects in other
endocrine cancers, which may nevertheless provide good palliation in some cases.