[Must cold nodules continue to remain absolute indications for surgery?].

The vast increase in thyroid operations in recent years, resulting partly from the continued development of nuclear diagnostic techniques, has led to the acquisition of new knowledge. Retrospective research on 6252 thyroid operations performed during the last 15 years shows an increase in the number of scintigraphically cold thyroid nodes, both absolutely and in relation to the total number of thyroid operations. With increased use of surgery, the malignancy rate in cases with cold thyroid nodes has fallen to 3.2%; the malignancy rate in cases where scintigraphy gave other results is 1.2%. Favorable developments have occurred in the earlier detection of cancer and in histologic diagnosis. In the 1960s, one-half of malignant goiter cases were first detected in stages III and IV of the TNM scala and could therefore be given only a palliative operation. Today, 80% of cases are detected and treated curatively in stage I. Whereas from 1964 to 1969 almost 50% of malignant goiters were histologically undifferentiated, today 90% are well-differentiated carcinomas. In view of these statistics, use of the scintigraphic diagnosis of cold thyroid nodes as an invariable indication for surgery should be reconsidered.