Thyroid carcinoma in an endemic area presenting as solitary thyroid nodules

A retrospective analysis of 66 cases of thyroid cancer presenting as a solitary thyroid nodule (STN) from an endemic area is presented herein. The workup included TSH estimation and radionuclide scanning and patients were divided into two groups. Group A included cases of STN carcinoma diagnosed histologically in patients clinically presenting as a benign STN. Of all the patients who presented with a benign STN, malignancy was found more frequently in 'cold' nodules (13.5 per cent), than in nodules with a different presentation on scintiscanning (0-9.5 per cent). Cancers occurred in 5 per cent of the females and in 19.5 per cent of the males. Group B included patients with overt signs of malignancy. In both groups, the clinical behaviour was determined by the stage at presentation according to TNM classification. TNM staging was found to be a good prognostic indicator, comparable to histopathology. Thus, locoregional recurrence and mortality were found to be higher in advanced T3 lesions and in Group B patients. On the basis of these findings it is suggested that STN cancers may either be an earlier stage of the disease or that the STN cancers in the two groups may be separate disease entities.