Metastatic carcinoma of the thyroid gland as the initial manifestation of the disease.

During the past 38 years, 260 patients with thyroid carcinoma have been operated upon at the University of California Hospital. In 26 of these patients the first symptom was a mass distant from the thyroid gland, and the gland was considered normal on clinical examination. In all but three of the 26 cases a small carcinoma of the thyroid gland was observed at operation or in pathological examination. Radical neck dissection with either total lobectomy or total thyroidectomy would seem to be the operation of choice in the treatment of these patients. The ultimate prognosis, even in the presence of metastases, is relatively good.Primary carcinoma of the thyroid gland should be considered in the presence of tumors of the side of the neck even in the absence of palpable nodules in the gland itself.