Characteristics and patterns of surgical interventions in differentiated thyroid cancer with distant metastasis

Objective: Unlike most head and neck cancers, the presence of distant metastasis (DM) does not preclude curative intent treatment and surgical interventions are common in metastatic disease. This research attempts to study the demographics, patterns of metastasis, and surgical interventions in patients of differentiated thyroid cancer (DTC) with DM. Materials and Methods: The retrospective cohort study of thirty-two patients of DTC with radiologically or histopathologically/cytopathologically confirmed DM who underwent surgery at a tertiary care center from August 2011 to December 2018. Results: The study population comprised of 59% of women and had a median age of 55 (19–79) years. Thorax was the most common site of metastasis, documented in 56% patients, while 53% of patients had bone metastases. Multiple DM were noted in 8 patients. Surgery for metastatic sites was possible in 14 patients (44%), with debulking and spine fixation being the most common surgical intervention for metastasis. The median dose of radioactive iodine (RAI) received by patients was 400 (25–749) mCi in one to four sessions (median-2 sessions). Three patients received conventional chemotherapy, while four received Sorafenib. Conclusion: Metastasectomy in DTC with DM is feasible in selected patients, and surgical interventions are most commonly performed on the spine to prevent neurological complications. RAI ablation is universally administered in this subset of patients and in very high doses, often distributed in multiple sessions. The role of chemotherapy and tyrosine kinase inhibitor is still restricted to palliative settings and cost constraints remain a detriment to more widespread use.