Prognostic Factors

Successful treatment of patients with distant metastases depends largely on the size, location, and number of metastatic lesions and their ability to take up radioiodine. Patients with micronodular diffuse lung metastases and, to a lesser extent, small metastases in bone revealed by WBS in the absence of radiographic abnormalities have the greatest chance of cure. This is particularly true in children, who often have this pattern of metastatic pulmonary spread and yet do exceptionally well after treatment with radioiodine therapy.2742 Patients with macronodules in the lung and large or multiple bone metastases have a poor prognosis, but long-term palliation and occasional cure can be accomplished by resection of these tumors in selected patients. Loss of radioiodine uptake by the metastatic tumor is also a prognostic indicator of a poor outcome. These findings emphasize the importance of early recognition and early treatment of distant metastases. This is best accomplished by total thyroidectomy or near-total thyroidectomy with postoperative ablation of the remnant, and then serum Tg determination and radioiodine scanning to detect micrometas-tases that can be successfully ablated with 131I.

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