Hyperthyroidism and concurrent thyroid carcinoma.

In the last twenty years, medical studies have reported a significant increase in thyroid neoplasms among patients with hyperthyroidism. Aim of the present work is to reconsider the real incidence of this not uncommon association and to establish a model for surgical treatment of hyperthyroidism for a possible concurrence with thyroid carcinoma. At the Department of Surgical Sciences and Applied Medical Technologies "La Sapienza" Rome's University, during the period 1994 to 1999, an homogeneous group of 82 patients was surgically treated for hyperthyroidism. Of our patients, fifty-four (66%) had a "multinodular toxic goiter" (MTG), twenty (24%) a "functional autonomous nodule" (FAN) while the remaining patients were affected by Graves' disease. The surgical procedures adopted were: 1) total extracapsular ipsilateral lobectomies and isthmectomies in sixteen patients with FAN; 2) total extracapsular thyroidectomy in all patients with MTG and with Graves' disease and in the remaining four patients with FAN after a long time treatment with thyrostatic drugs. On six (7%) of our patients we found out a thyroid carcinoma: five with MTG and one with Graves' disease. However, no association with thyroid carcinoma was observed in anyone with FAN. The correct treatment of thyroid surgical diseases is a single definitive operative approach. The procedure must be a total thyroidectomy in MTG and Graves' disease. However, in patients with FAN it's possible, after careful evaluation, to carry out a total extracapsular ipsilateral lobectomy with isthmectomy, justified by the normal morphology of the remaining thyroid tissue. It is always possible, in these cases, a subsequent complete exeresis if a carcinoma is present in the removed lobe.