THE TREATMENT OF NODULAR GOITER

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Abstract
200 patients with nodular goiter were treated by thyroidectomy. 25 of these were found to have malignant neoplasms with an incidence of 14.4% in solitary nodules and 10.4% in multiple nodules. The clinical estimate of nodularity was frequently in error since many single nodules proved to be multiple on pathologic examination and in occasional instances diffuse enlargement proved to consist of multiple or single nodules. The great majority of the carcinomatous nodules were asymptomatic and clinically indistinguishable from benign nodules. 21 of the cancers were of low grade malignancy and consisted of papillary carcinomas or angio-invasive adenomas. Follow-up periods of from 1 to 17 yrs., with an avg. of 7 yrs., demonstrated that thyroidectomy without radical neck dissection was frequently adequate to secure prolonged survival of many years duration. The surgery of thyroid nodules is attended with a significant incidences of recurrent laryngeal nerve injuries. Cancer of the thyroid exhibits a histologic pattern of carcinoma but behaves biologically in most varied fashion. It is concluded that surgical exploration is necessary to establish the nature of thyroid nodules and to extirpate cancer if present.
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