Thyroid carcinoma presenting as a regional neck mass

During 1978-1988, we treated 197 patients with thyroid carcinoma. Twenty-seven patients (14.0%) presented with a regional cervical mass and a clinically normal thyroid gland on initial evaluation. Excisional biopsy proved the diagnosis of metastatic thyroid carcinoma in every patient. Subsequent thyroid scans were 42% sensitive. Only 3 patients underwent fine-needle aspirations; none showed evidence of malignant cells. Review of surgical specimens showed total involvement of the gland in 13 of 17 cases, with extracapsular spread of tumor in 3 patients. Multicentric disease was present in all but 2 neck specimens. Patient follow-up from 1 month to 10 years revealed an 11.5% recurrence rate. The results in this group of patients is compared to the larger group of thyroid carcinoma patients, where three recurrences were found in 170 patients presenting with a clinically palpable mass in the thyroid gland. Analysis of our population comparing the subgroup with the larger series of thyroid carcinoma patients suggests that thyroid carcinoma presenting as a regional neck mass is a more aggressive disease.