Aims

In 1980 a Thyroid Cancer Clinic was set up at Royal Brisbane Hospital [RBH] to manage complex Thyroid Cancer patients. The clinic evolved management guidelines based on international best practice.

Methods

Patients with a new diagnosis of thyroid cancer were seen and discussed with their pathology and imaging. RBH is the only facility in Queensland offering high dose I131 for ablation and therapy. External beam radiation therapy is reserved for symptomatic disease not responsive to I 131 and poorly differentiated and anaplastic tumours.

Results

Since 1980 the population of Queensland has risen from  2.42 million  to   4.56 million . The incidence of thyroid cancer has risen from  4.1 to 16.1 per 100,000 in females and 1.6 to 5.4 in males. The age range is from 7 to 91 .   The clinic has managed 4158 patients.

The overall disease specific survival is 85% at 25 years. However for the majority in the well differentiated cohort [Papillary and Follicular] the survival rate is 87% . Significant multivariate survival variables are  Sex [p=0.005, HR 0.68, 95%CI 0.52-0.89]  Age [p=<0.001, HR1.05, 95%CI 1.04-1.06]   T stage only T4 is significant [p=<0.001, HR 6.20,95%CI 4.01-9.57]  M stage [p=<0.001,HR 4.13, 95%CI 3.02-5.67]  Nodal disease  approaches significance in the multivariate  model [p=0.09, HR1.28, 95%CI 0.96-1.71]  but is highly significant in an age partitioned univariate  analysis .

Conclusion

Despite rapidly rising incidence  mortality has remained stable.

Significant management changes  include:

Functional neck dissection rather than “Berry Picking”

Raising  the threshold for offering I 131 ablation

Use of recombinant TSH as conditioning for I131 ablation

 The use of 1000MBq I 131 instead of 4000MBq as the standard ablation dose

Replacing follow up I 131 scans with tumour marker studies using Thyroglobulin

Utilising a risk adapted approach to thyroxine replacement.