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The histories of 358 patients with carcinomas of the thyroid have been evaluated. Differentiated carcinomas of the thyroid (84.6%) were treated by means of thyroidectomy, ablative radio-iodine therapy (tissue dose 1000 Gray), TSH-suppressive thyroid hormone medication and, in special cases, external radiation. Even differentiated carcinomas showed a high recurrence rate. Metastases occurred particularly in the lungs, the skeleton and locally; low iodine uptake, particularly in distant metastases from papillary carcinomas, often made it impossible to reach a diagnosis by using radio-iodine. Some pulmonary metastases could only be demonstrated radiologically and some skeletal metastases could be shown radiologically or scintigraphically. A modified follow-up program for differentiated carcinomas is suggested, based on the highly sensitive and specific thyroglobulin determination under TSH suppression (sensitivity 97.9%, specificity 93.6%).

The therapeutic approach in malignant goitre is fairly uniform, apart from use of percutaneous irradiation. The influence of irradiation on survival rate in differentiated carcinomas transgressing organ boundaries was assessed in the evaluation of treatment results in 621 patients (two patient groups: 1960-1980). Early stages of tumour (T0-T1) were seen in only 18% of cases; 24% of all cases had metastases, mainly of the lungs and skeleton. Males died 1.5 times more frequently due to differentiated tumours than did females The 10-year-survival rate was 90% in patients below the age of 50 years in contrast to 60% in older patients. Papillary carcinomas had such a survival rate in 78% and follicular carcinomas in 66%. Stages T0-T2 had a survival of 87% in contrast to 58% in stage T3. Occurrence of distant metastases diminished survival to 48%. 167 patients with irradiation (I) and 73 without (II), but an otherwise equal treatment, with differentiated carcinoma stage T3 could be compared. Group I showed a 5- and 8-year survival of 88% and 75%, group II 68% and 38% (P less than 0.001). Local recurrence was the same in both groups, however metastases occurred more frequently and earlier in group II.