Is Surgery Indicated in All Cases of Nodular Goiter, Toxic and Nontoxic?

From an analysis of the data presented in this paper we believe the following two theses to be true: All nontoxic nodular goiters—single and multiple—should be removed surgically because of the high incidence of unsuspected cancer, a rate which exceeds that of cancer of the breast in the clinically benign appearing group. Toxic nodular goiters should be removed surgically and should not be treated with thiouracil. Two recent papers¹have emphasized the high incidence of malignant degeneration in nodular goiters. Ward¹presented an incidence of 4.8 per cent in 3,539 nodular goiters of both sexes. In males the incidence was 11 per cent and in females 4.0 per cent. Cole and his associates¹showed the incidence of carcinoma in 523 nodular goiters (including toxic, nontoxic, benign and malignant) to be 7.2 per cent. However, a breakdown of their cases revealed the following extraordinary facts: In