Thyroid carcinoma; an approach to management of the disease

A clinical and pathological study was made of a series of 34 consecutive patients with thyroid carcinoma. Carcinoma occurred only in nodular goiters, and in the majority of cases was found in a gland with a solitary nodule. The degree of firmness to palpation of a thyroid nodule is unimportant in the diagnosis of carcinoma of the thyroid since hardness was an infrequent finding. In the diagnostic use of radioactive iodine, scintigram studies of a nodular goiter usually revealed an area of decreased function at the site of a thyroid carcinoma.Twenty-three per cent of the 34 patients with thyroid carcinoma died within five years. The duration of survival for various patients was compared with the type of treatment administered. It is believed that solitary thyroid nodules are best treated by lobectomy. Total thyroidectomy is indicated in cases of large thyroid carcinoma and also for smaller tumors if papillary adenocarcinoma. Radical neck dissection is warranted if lymph node metastasis is present and limited to the neck; and also in the absence of metastasis if the tumor is papillary in histologic pattern. Surgically inaccessible metastatic lesions are best palliated by radioactive iodine or external irradiation.