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Treatment and outcome of patients with Graves’ disease and metastatic differentiated thyroid cancer

Nikola Besic
Nikola Besic
 and 
Barbara Vidergar-Kralj
Barbara Vidergar-Kralj
   | Sep 04, 2023
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Article Category: Research Article
Published Online: Sep 04, 2023
Page range: 380 - 388
Received: Mar 21, 2023
Accepted: Jun 19, 2023
DOI: https://doi.org/10.2478/raon-2023-0034
Keywords
© 2023 Nikola Besic et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

A 75-year-old patient was operated on after preparation with thiamazole for a pathological fracture of Th2. Spinal stabilization was performed.
A 75-year-old patient was operated on after preparation with thiamazole for a pathological fracture of Th2. Spinal stabilization was performed.

FIGURE 2.

Disease-specific survival of patients with Graves’ disease (GD) and without GD.
Disease-specific survival of patients with Graves’ disease (GD) and without GD.

FIGURE 3.

Overall survival of patients with Graves’ disease (GD) and without GD.
Overall survival of patients with Graves’ disease (GD) and without GD.

Treatment of patients and their outcome

Factor Subgroup All patients (N = 28) Without Graves’ disease (N = 24) With Graves’ disease (N = 4) p-value
Thyroid surgery No 8 7 1 1.00
Yes 20 17 3
Thyroid surgical procedure Total or near-total thyroidectomy Lobectomy or less 18 15 3 1.00
10 9 1
Residual tumor after surgery No surgery 8 7 1 0.916
R0 (without residual tumor) 11 9 2
R1 2 2 0
R2 7 6 1
Neck dissection No 24 21 3 0.481
Yes 4 3 1
Surgery of distant metastases No 26 24 2 0.016
Yes 2 0 2
RAI ablation after surgery No 10 9 1 1.00
Yes 18 15 3
Therapy with RAI No 10 9 1 1.00
Yes 18 15 3
EBRT to the neck No 21 17 4 0.545
Yes 7 7 0
EBRT (any site) No 15 13 2 1.00
Yes 13 11 2
Preoperative chemotherapy No 25 23 2 0.045
Yes 3 1 2
Chemotherapy No 22 20 2 0.191
Yes 6 4 2
Targeted therapy No 18 16 2 0.601
Yes 10 8 2
Outcome Alive with disease 9 7 2 0.461
Dead of disease 15 14 1
Dead of other causes 4 3 1

Clinical characteristics and pathological characteristics of tumors

Factor Subgroup All patients (N = 28) Without Graves’ disease (N = 24) With Graves’ disease (N = 4) p-value
Mean age of patients (year) 73.86 74.25 71.50 0.359
Mean primary tumor size (cm) 5.604 5.483 6.325 0.355
Gender Female 20 19 1 0.058
Male 8 5 3
Age (years) 54 or less 1 1 0 1.00
55 or more 27 23 4
Hyperthyreosis at presentation No 23 23 0 0.001
Yes 5 1 4
Functional metastases No 26 24 2 0.016
Yes 2 0 2
Tumor diameter (cm) 0–4 9 8 1 1.00
4.01 and more 19 16 3
pT tumor stage pTx, pT1 or pT2 7 6 1 0.522
pT3 7 5 2
pT4 14 13 1
N stage N0 20 17 3 1.00
N1 or N2 8 7 1
M stage M0 0 0 0 -
M1 28 24 4
Type of metastases Lung only 11 10 1 0.759
Bones and others 12 9 3
Lungs and others without bones 5 5 0
Single organ metastases No 14 11 3 0.596
Yes 14 13 1
Tumor type Papillary 14 12 1 0.279
Hürthle 6 4 2
Follicular 5 5 0
Poorly differentiated 3 3 1
Tumor differentiation (N = 19) Well 6 5 1 1.00
Moderate or poor 13 12 1
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