The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters.

The incidence of carcinoma in patients with multinodular goiters has been reported to be considerably lower than in patients with a single cold nodule. However, the definition of a "single cold nodule" is highly subjective and has therefore been modified by qualifiers such as "clinically solitary" or "clinically dominant." In this retrospective study, we find no significant difference in the incidence of carcinoma in patients with multinodular goiters compared with patients with a solitary cold nodule confirmed by operation and histopathologic examination. In a consecutive series of thyroidectomies over a 22-year period, all patients with factors predisposing them to neoplasia, such as a history of radiation exposure and thyroiditis, were eliminated. Furthermore, all patients thought to have additional nodules documented by gross examination at operation or subsequently by histopathologic examination were also eliminated. The remaining 69 patients with clinically evident multinodular goiters were compared with the remaining 96 patients with a solitary cold nodule. The incidence of carcinoma in the 96 patients with a solitary cold nodule was 17%. In the 69 patients with clinically evident multinodular goiters, the incidence of carcinoma was 13%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 29%, whereas, males with a solitary cold nodule had an incidence of only 13%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiters.