Carcinoma of the Thyroid Gland

Thyroid carcinoma; an approach to management of the disease

A clinical and pathological study was made of a series of 34 consecutive patients with thyroid carcinoma. Carcinoma occurred only in nodular goiters, and in the majority of cases was found in a gland with a solitary nodule. The degree of firmness to palpation of a thyroid nodule is unimportant in the diagnosis of carcinoma of the thyroid since hardness was an infrequent finding. In the diagnostic use of radioactive iodine, scintigram studies of a nodular goiter usually revealed an area of decreased function at the site of a thyroid carcinoma.Twenty-three per cent of the 34 patients with thyroid carcinoma died within five years. The duration of survival for various patients was compared with the type of treatment administered. It is believed that solitary thyroid nodules are best treated by lobectomy. Total thyroidectomy is indicated in cases of large thyroid carcinoma and also for smaller tumors if papillary adenocarcinoma. Radical neck dissection is warranted if lymph node metastasis is present and limited to the neck; and also in the absence of metastasis if the tumor is papillary in histologic pattern. Surgically inaccessible metastatic lesions are best palliated by radioactive iodine or external irradiation.

Carcinoma of the thyroid gland

Sixty-three cases of cancer of the thyroid gland were studied. In 16 cases the cancer arose in an adenoma-without clinical evidence of carcinoma in any instance.Hoarseness, dyspnea and dysphagia, fixation and hardness, and slow enlargement of the lateral lymph nodes were the most common diagnostic signs and symptoms. The most common avenue of spread is the lymphatic system. In two-thirds of the cases in which metastasis occurred, the cervical nodes were involved. Prognosis is related to the histologic type of the lesion. Of 35 patients observed for five years after treatment, ten had no evidence of disease at the end of that time. Twenty were followed for ten years and four of them apparently were free of cancer. The trend in treatment is toward more extensive surgical dissection. In inoperable cases, irradiation has been used with some benefit.