Differentiated thyroid cancer in patients ≥75 years: Histopathological features and results of surgical treatment

• Age as prognostic factor for thyroid cancer is a matter of debate.
• Differentiated thyroid carcinoma is more aggressive in elderly patients.
• Surgery is the treatment of choice for differentiated thyroid carcinoma in all ages when performed by skilled surgeons.

IntroductionThe aim of this retrospective study was to investigate clinical and pathologic characteristics of differentiated thyroid cancer (DTC) in patients ≥75 years and to analyze results of surgical treatment in this age group.MethodsThe clinical records of patients submitted to total thyroidectomy between 2009 and 2014 with histopathological diagnosis of DTC were analyzed. Patients were divided into 3 groups: patients ≤64 years were included in group A, those between 65 and 74 in B and those ≥75 years in C.ResultsClassic papillary thyroid cancer was more frequent in group A, whereas follicular variant of papillary carcinoma, tall cell and follicular carcinoma were more frequent in C. Multicentric and locally invasive tumors were more frequent in group C; younger patients (group A) showed higher incidence of node metastases (12.54% in group A, 6.33% in B and 7.89% in C). Postoperative stay was significantly longer in group C (3.13 ± 1.28 days vs 2.55 ± 1.27 vs 2.89 ± 1.27; p < 0.001). Transient hypoparathyroidism was more frequent in groups A and B compared with C (29.26% vs 19.71% vs 18.42%; p 0.033) whereas transient recurrent laryngeal nerve palsy was more frequent in group C compared with A and B (2.63% vs 0.16% vs 2.11% p 0.009).ConclusionsIn aging patients DTC show a worse prognosis compared with younger patients due to higher incidence of more aggressive histotypes but also to a significant diagnostic delay. Total thyroidectomy is safe when surgical operation is performed by skilled surgeons. Age alone does not exclude surgical option.