Deaths related to differentiated thyroid cancer: a rare but real event

Abstract

Objective: The present study describes the clinical and tumor characteristics of patients that died from differentiated thyroid cancer and reports on the cause and circumstances of death in these cases. Subjects and methods: Retrospective analysis of all the differentiated thyroid cancer (DTC) related deaths at a single institution over a 5-year period, with a total of 33 patients. Results: Most of the patients were female (63.6%), with a mean age at diagnosis of 58.2 years. The most common histologic type was papillary (66.7%) and 30.3% were follicular. The distribution according to the TNM classification was: 15.4% of T1; 7.7% T2; 38.4% T3; 19.2% of T4a and 19.2% of T4b. Forty-four percent of cases were N0; 20% N1a and 36.6% of N1b. Twelve patients were considered non-responsive to radioiodine. Only one of the patients did not have distant metastases. The most common metastatic site was the lung in 69.7%. The majority of deaths were due to pulmonary complications related to lung metastases (17 patients, 51.5%), followed by post-operative complications in 5 cases, neurological disease progression in 3 cases, local invasion and airway obstruction in one patient. Median survival between diagnosis and death was reached in 49 months while between disease progression and death it was at 22 months. Conclusion: Mortality from DTC is extremely rare but persists, and the main causes of death derive from distant metastasis, especially respiratory failure due to lung metastasis. Once disease progression is established, median survival was only 22 months. Arch Endocrinol Metab. 2017;61(3):222-7.

Thyroid Cancer Overdiagnosis and Overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador 

“…Another driver of the increased thyroid cancer mortality in Ecuador, not assessed in this study, may be attribution bias. That is, patients with thyroid cancer who died, and the cause of death is attributed to thyroid cancer even if cancer was likely not the cause of death 42 . This misclassi cation bias exaggerates cancer-speci c mortality.…”

Incidental diagnosis and surgery outcomes of thyroid cancer in Ecuador

“…Another driver of the increased thyroid cancer mortality in Ecuador, not assessed in this study, maybe attribution bias. That is, patients with thyroid cancer who died, and the cause of death is attributed to thyroid cancer even if cancer was likely not it due 40 . This misclassification bias exaggerates cancer-specific mortality.…”

Two themes in thyroid cancer: artful diagnosis and shortened lives

“…(17), analyzes deaths related to differentiated thyroid cancer (DTC). Current trends in management have moved us to be less aggressive in the treatment and management of DTC, practicing the so called "less is more" philosophy.…”