{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:38:02Z","timestamp":1787495882893,"version":"build-2736575974"},"reference-count":23,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T00:00:00Z","timestamp":1346457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Distant metastases at presentation are rare in well-differentiated thyroid cancer (WDTC). The objective of this study was to report outcomes for patients presenting with distant metastases managed by thyroidectomy and radioactive iodine (RAI) therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Fifty-two patients with distant metastases from thyroid cancer diagnosed before thyroid surgery (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =32) or on a postoperative RAI scan after thyroid surgery (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =20) were identified from a database of patients with WDTC treated between 1985 and 2005. The median age was 58 years (range 12\u201383 years), with a male-to-female ratio of 3:2. Forty-seven patients (90%) had total thyroidectomy and two (4%) had thyroid lobectomy, and three patients (6%) were found to be unresectable. Distant metastases were classified into pulmonary and extrapulmonary. Overall survival (OS), disease-specific survival (DSS), and locoregional recurrence-free survival were calculated by the Kaplan\u2013Meier method. Factors predictive of the outcome were determined by univariate and multivariate analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Thirty-nine patients (75%) were diagnosed with pulmonary metastases alone and 13 (25%) with extrapulmonary metastases. The sites of extrapulmonary metastases were bone in nine, mediastinum in one, pyriform sinus in one and skin in one, and one patient had synchronous lung, bone, and intracerebral metastases. After thyroid surgery, 47 patients (90%) were treated with RAI alone, and 2 patients had external beam radiation in addition to RAI. With a median follow-up after surgery of 78.5 months, the 5-year OS and DSS were 65% and 68%, respectively. Twenty-nine patients (56%) died during follow-up, of whom 24 (46%) died of thyroid cancer. Six patients (12%) developed recurrent disease in the lateral neck, and three patients (6%) developed recurrence in the thyroid bed. Over 45 years, follicular pathology and extrapulmonary metastases were predictive of lower 5-year DSS (56% vs. 100%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt;0.001; 50% vs. 70%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =0.004; and 46% vs. 75%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =0.013, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Approximately half of patients with WDTC presenting with distant metastases die of disease within 5 years of initial diagnosis despite thyroid surgery and RAI. Age over 45 years, extrapulmonary metastases, and follicular pathology were significant predictors of the poor outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2011.0535","type":"journal-article","created":{"date-parts":[[2012,7,24]],"date-time":"2012-07-24T11:07:42Z","timestamp":1343128062000},"page":"884-889","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":212,"title":["The Impact of Distant Metastases at Presentation on Prognosis in Patients with Differentiated Carcinoma of the Thyroid Gland"],"prefix":"10.1177","volume":"22","author":[{"given":"Iain J.","family":"Nixon","sequence":"first","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Whitcher","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank L.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Michael","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok R.","family":"Shaha","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jatin P.","family":"Shah","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snehal G.","family":"Patel","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Ganly","sequence":"additional","affiliation":[{"name":"Memorial Sloan-Kettering Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,9,1]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"2041","article-title":"Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades","volume":"80","author":"Dinneen SF","year":"1995","unstructured":"Dinneen SF, , Valimaki MJ, , Bergstralh EJ, , Goellner JR, , Gorman CA, , Hay ID. 1995. 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Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery, 114:1050\u20131057discussion 1057\u20131058.","journal-title":"Surgery"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2009.0110"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6060(98)70034-0"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006231-200409000-00006"},{"key":"e_1_3_2_18_2","first-page":"52","article-title":"[European consensus on the management of patients with differentiated carcinoma of the thyroid from follicular epithelium]","volume":"167","author":"Pacini F","year":"2008","unstructured":"Pacini F, , Schlumberger M, , Dralle H, , Ilisea R, , Smith Y, , Viersinga V. 2008. 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