Follicular thyroid cancer natural history, complications and prognosis

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

• Natural history of follicular thyroid cancer is variable.
• Symptoms of follicular thyroid cancer usually develop in the fourth decade of life.
• The condition presents as a slowly enlarging painless mass.
• Without treatment, patients will develop symptoms caused by compression and metastasis, such as hoarseness of voice, difficulty swallowing, and difficulty breathing.^[1]

Common complications of follicular thyroid cancer include:^[2]

• Metastasis
• Hoarseness of voice
• Dysphagia
• Dyspnea

• Prognosis of follicular thyroid cancer is directly related to tumor size.^[3]
  • Good Prognostic Factors:
    • Children
    • Adolescent
    • Women younger than 50
    • Men younger than 40
  • Bad 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
• Stage Related Prognosis
  • The 10-year survival is better for patients with follicular carcinoma without vascular invasion than it is for patients with vascular invasion.
  • Follicular carcinoma invading the cervical tissue has a worse prognosis than tumors confined to the thyroid gland.
  • The presence of vascular invasion is an additional poor prognostic factor.
  • Metastasis to lymph nodes do not worsen the prognosis in patients younger than 45 years.
  • The prognosis for patients with distant metastases is poor.

• 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.