Prognosis and morbidity after total thyroidectomy for papillary, follicular and medullary thyroid cancer.

The prognosis and the morbidity results after total thyroidectomy are reported for 148 patients with differentiated thyroid cancer. Ninety-two patients (62%) had papillary cancer, 27 (18%) had follicular cancer and 29 (20%) had medullary cancer. In the latter group, 16 patients had no clinical signs of a tumour and underwent total thyroidectomy after elevated calcitonin levels were found in a family screening programme. The mean follow-up period was 9.7 years in the present series. The 5- and 10-year overall survival in the patient group with papillary cancer was 97% and 95% respectively, in the group with follicular cancer it was 78% and 50% respectively and in the group with medullary cancer it was 91% and 82% respectively. Significantly associated with reduced disease-free survival were: extrathyroidal growth (P less than 0.0001), distant metastases at diagnosis (P less than 0.0001), follicular histology (P less than 0.0001), age over 40 (P less than 0.001) and male sex (P less than 0.05). In patients with papillary cancer, recurrences were in most cases located in the neck, while recurrences at distant sites were encountered more frequently in patients with follicular or medullary cancer. Accidental permanent unilateral recurrent laryngeal nerve palsy were registered in 1.4% of the nerves at risk; all on the side of the tumour. Permanent hypoparathyroidism was present in 4% of the patients.