Follicular thyroid cancer natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Depending on the extent of the tumor at the time of diagnosis, the prognosis of follicular thyroid cancer may vary. However, the prognosis is generally regarded as poor. The presence of metastasis is associated with a particularly poor prognosis among patients with follicular thyroid cancer.

Natural History

The natural history of follicular thyroid cancer is variable. The symptoms of follicular thyroid cancer usually develop in the fourth decade of life, and start with symptoms such as a slowly enlarging painless mass. Without treatment, the patient will develop symptoms of compression and metastasis such as hoarseness of voice, dysphagia, and dyspnea.

Complications

• Metastasis
• Hoarseness of voice
• Dysphagia
• Dyspnea

Prognosis

• Prognosis of follicular thyroid cancer is directly related to tumor size.

Worst Prognostic Factors

• Women older than 50 with follicular carcinoma
• Men older than 40 with follicular carcinoma
• Distant metastasis
• Large tumor size
• Extensive vascular invasion
• Extra thyroidal extension
• Widely invasive tumors

Intermediate Prognostic Factors

• Women older than 50 with papillary carcinoma
• Men older than 40 with papillary carcinoma

Good Prognostic Factors

• Children
• Adolescent
• Women younger than 50
• Men younger than 40

5 year Relative Survival Rate

• 5 year relative survival rate of follicular thyroid cancer depends on the stage of the disease at the time of diagnosis.
• Stage 1 has 100% 5 year relative survival rate
• Stage 2 has 100% 5 year relative survival rate
• Stage 3 has 71% 5 year relative survival rate
• Stage 4 has 50% 5 year relative survival rate