THYROID OPERATIONS. A REVIEW OF 364 CONSECUTIVE CASES.

Three hundred sixty-four operations on the thyroid gland done in a five year period (1956-1961) in two private suburban Los Angeles Hospitals were reviewed. Two hundred twenty-three of the operations were done for the treatment of solitary nodular goiter (clinical diagnosis). Twenty-three cancers were found, an incidence of 10.5 per cent. Only one cancer was definitely diagnosed preoperatively. Multinodular non-toxic goiters were diagnosed clinically in 39 cases and two cancers were present. Cancer was not found in the 23 cases of nodular toxic goiter.Graves' disease was treated surgically in 35 cases, or almost 10 per cent of the total series. In four the microscopic appearance of Hashimoto's thyroiditis was present. Thyroiditis was diagnosed by the pathologist in 51 instances, or about 14 per cent of the series. It was Hashimoto's thyroiditis in 40 cases. Three cancers were found associated with Hashimoto's thyroiditis. There was nothing definitely diagnostic about the protein-bound iodine test or the I(131) uptake test or scan in nodular goiter, thyroiditis or cancer. Cancer was found in six "cold" nodules, in one hypofunctioning nodule and in one "warm" nodule. Cancer was not found in any cases clinically diagnosed as toxic nodular goiter. The clinical accuracy of the preoperative diagnosis was 70 per cent for solitary nodular goiter and 90 per cent for multinodular goiter. Only three cases of Hashimoto's thyroiditis were definitely diagnosed preoperatively. Needle biopsy was not done.Eighty-six per cent of the cancers were papillary, mixed or follicular; 14 per cent were anaplastic. In 24 per cent of the cases of cancer there was local invasion or metastasis to lymph nodes, lung or bone by the time operation was done.