We have analyzed data on a group of 269 patients with papillary thyroid carcinoma followed on average for 12 years to determine (1) if a prognostic classification scheme can be used to predict an appropriate surgical approach; (2) the effect of treatment on prognosis; and (3) if patients with a "excellent" prognosis benefit from more extensive surgical resection and 131I ablation. Prognostic classification schemes developed by the American Joint Commission, Cady et al., Hay et al., the European Thyroid Association, and our own clinical class scheme each appropriately divided patients into risk category groups. With each system, some patients classified in the low risk group eventually died of the tumor. Considering the excellent but not perfect precision of the prognostic schemes, the need for detailed pathologic analysis, and ideally postoperative thyroid scanning, we conclude that the prognostic classification schemes do not allow the decision at the operating table regarding the appropriate extent of surgery. Patients followed at our institution, operated on by one of three experienced surgeons, and usually given 131I ablation were compared to other patients in the follow-up group operated on by other surgeons and not routinely ablated. There were significantly fewer deaths and recurrences among the patients managed by our method. However, when the groups were restricted to those considering only patients who had more extensive surgery, postoperative 131I ablation, or both, the differences between the groups became insignificant. This finding indicates that the difference in prognosis, comparing patients treated at our institution and those initially treated elsewhere, was primarily due to the routine use of more extensive surgery and postoperative radioactive iodide ablation.(ABSTRACT TRUNCATED AT 250 WORDS)

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T3 receptor occupancy and metabolic responses.

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Effect of plasmapheresis and steroid treatment on thyrotropin binding inhibitory immunoglobulins in a patient with exophthalmos and a patient with pretibial myxedema.

The effect of prednisone treatment and plasmapheresis was studied in two patients with Graves' disease complicated by severe exophthalmos and/or pretibial myxedema. Titers of Thyrotropin Binding Inhibitory Immunoglobulins (TBII), Long Acting Thyroid Stimulator (LATS), antithyroid antibodies, and serum gammaglobulin concentrations, as well as clinical changes in exophthalmos and pretibial myxedema, were observed during the course of treatment. Steroid treatment lowered all of the abnormal antibody titers. Plasmapheresis did not change the TBII activity when determined using a fixed amount of immunoglobulin G fraction. However, serum gammaglobulin concentration was reduced by plasmapheresis, and therefore, total TBII activity in a unit of serum was reduced. Plasmapheresis also partially and temporarily resolved the pretibial myxedema, whereas no significant change in exophthalmos was observed. These results suggest that both steroid and plasmapheresis treatment are useful for lowering abnormal antibody titers in sera of patients with Graves' disease, and that plasmapheresis can be of some value in the treatment of pretibial myxedema.

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