Background

Papillary carcinoma thyroid is the commonest malignancy affecting the thyroid gland. Therecommended treatment is total thyroidectomy followed by radioactive iodine therapy depending on various factors. Radioactive iodine facilities are not present in most of the hospitals. The patients are followed up with suppressive dose of thyroxine alone.  As the disease process itself is quite slow most of the patients are long time survivors. Thus adequate evaluation of radio iodine therapy becomes a time consuming process and patients may be lost in follow up. This is further compounded by the fact radio iodine requirement is debated in intermediate risk group with further on–going studies. The database from these hospitals would be eye opener in this situation.

 In the year 2016, 123 patients visited the hospital on follow up with at least 5 years after treatment of papillary carcinoma thyroid. As per the prevailing ATA guidelines 61 patients should have received radio iodine. Seven of these patients had taken radio iodine in private centres. The remaining 116 patients did not receive radio iodine. As per the MACIS score 42 patients should have received radioactive iodine. The MACIS score of the patients who received radio iodine showed 3 had a score of less than 6 and 4 had a score of more than 6.All the 4 patients had metastatic disease at presentation.Seven patients with a MACIS score more than 6 had developed recurrent disease in follow up, among these 2 of them had received radio iodine therapy. None of the 81 patients with MACIS score of less than 6 developedrecurrences.

Conclusion

Recurrent disease can be predicted with MACIS scoring. This score is an excellent tool in analysis of patients who might have aggressive diseases. Patients with a score of less than 6 can be confidently reassured of cure. This score should be applied in all patients with regard to further treatment and aggressive follow–up. Further studies have to be taken up with other parameters like histological grade along with this score to delineate necessary modifications in therapy.