Distant metastasis (DM) is seldom observed at initial presentation of differentiated thyroid carcinoma (DTC), making it difficult to assess the clinical characteristics and treatment outcomes of DTC patients with DM. We therefore retrospectively assessed these parameters in DTC patients who presented with DM between July 1994 and December 2007. In addition, we compared biologic behaviors and prognostic factors between patients presenting with DM and those developing DM after initial treatment. Among 1560 DTC patients who underwent thyroidectomies during the 13.5-year study period, 91 patients were included in this study; 52 patients (3.4%) displayed DM at initial presentation and 39 (2.5%) developed DM after initial 131radiacitive iodine (RI) treatment. Metastatic lesions were treated with high dose RI (94.5%), surgical resection (14.3%), external beam radiation therapy (31.9%), embolization of feeding vessels (1.1%), and/or chemotherapy (1.1%). Median duration of follow-up was 75 months (range, 12–158 months). Mean patient age was 57 years (range, 13–80 years), and the female-to-male ratio was 2.03:1. Metastases were detected in the lung only (68.1%), bone only (16.5%), and multiple sites (15.4%). When clinical and tumor characteristics were considered, metastatic lesion iodine avidity was significantly higher in patients presenting with DM. At 5 and 10 years, the overall survival (OS) rates in patients presenting with DM were 83.8% and 72.1%, respectively, and the disease-specific survival (DSS) rates were 68.5% and 26.8%. OS did not differ significantly between patients presenting with DM and those developing DM after initial treatment. However, those with initial DM enjoyed significantly improved DSS compared with patients who developed DM after initial treatment. At last follow-up, 22 patients (24.2%) were alive without disease, 48 (52.7%) were alive with disease, and 21 (23.1%) had died of disease in study patients. Multivariate Cox's regression analyses showed that complete local control was a significant predictor of OS and DSS in all study patients. In patients developing DM after initial treatment, metastatic lesion iodine avidity was also associated with both OS and DSS. In contrast, avidity was associated only with DSS in patients presenting with DM. Our study showed that DTC patients presenting with initial DM appear to have relatively favorable outcomes compared with DTC patients who developed DM after initial treatment. Complete local control may be the most important prognostic indicator in all DM patients. Metastatic lesion iodine avidity had a significant impact on both OS and DSS in patients developing DM after initial treatment, but significantly influenced only DSS in patients presenting with initial DM.

The objectives of this study were to compare long-term outcomes after total thyroidectomy (TT) or thyroid lobectomy (LT) in a large cohort of patients with papillary thyroid microcarcinoma (PTMC), and to determine whether tumor size (≤0.5 cm vs. >0.5 cm) has a significant impact on the extent of surgery. We evaluated 2014 patients with PTMC who underwent TT with central compartment node dissection (CCND; n = 1015) or LT with CCND (n = 999) between March 1986 and December 2006 and for whom complete follow-up data were available for at least 5 years (median 11.8 years, range 5-26 years). Using propensity score matching to reduce the impact of treatment selection bias and potential confounding in an observational study, we compared overall survival and disease-free survival in the overall cohort and in patients with tumors ≤0.5 cm and >0.5 cm in size. After adjustment for differences in baseline clinicopathologic risk factors, we observed no significant differences between the LT and the TT groups in the risk of death (hazard ratio for the LT group 1.05, 95% confidence interval [CI] 0.71-1.47, p = 0.890) and locoregional recurrence (hazard ratio for the LT group 3.08 [CI 1.99-8.05], p = 0.194) in the overall matched cohort. Similar results were observed when we compared LT and TT in patients with tumors ≤0.5 cm and >0.5 cm. The long-term rates of death and locoregional recurrence were similar in patients with PTMC who underwent LT with CCND and those who underwent TT with CCND. Therefore, completion thyroidectomy may not be recommended unless recurrence after LT is definitely detected in low-risk PTMC patients, and close follow-up is adequate in these patients. Moreover, tumor size greater than or less than 0.5 cm was not a significant determinant of the extent of surgery in patients with PTMC.

Percutaneous ethanol injection therapy (PEIT) has been used to treat various human neoplasms. We evaluated the local therapeutic effect of PEIT in recurrent thyroid cancers. From October 2002 to September 2005, we performed ultrasound-guided PEIT on 24 recurrent lesions (eight in thyroid beds and 16 in neck nodes) of 16 papillary thyroid carcinoma patients. Ethanol was injected at 3-month intervals under sonographic guidance. All patients tolerated PEIT well with only mild local pain, although one patient complained of transient hoarseness after the procedure. The median diameter of lesions was significantly reduced, from 9.9 mm (range, 5.5-25.0 mm) to 5.3 mm (range, 0.0-17.0 mm) by PEIT. Four recurrent lesions disappeared sonographically. PEIT may be an alternative treatment option for locally recurrent thyroid carcinomas in properly selected patients. However, a prospective, long-term follow-up study is necessary to determine the effect of PEIT on patient survival and tumor recurrence.

Robotic thyroidectomy is an emerging technique with postoperative outcomes that are at least comparable to those of conventional endoscopic thyroidectomy, with some end-points appearing superior. Our multicenter series represents the largest comparison of robotic and endoscopic thyroidectomy to date, with results suggesting a comparable robot technology we used that could overcome some of the technical limitations associated with conventional endoscopic procedures, with reduced operation times and increased lymph node retrieval. Moreover, we found that the learning curve for robotic thyroidectomy was shorter than that for endoscopic thyroidectomy.