The Problem of Malignancy in Nodular Goiter-Recapitulation and a Challenge

The relation of thyroid cancer to nontoxic nodular goiter and to initially benign thyroid adenomas has been the subject of prolonged and vehement controversy. Some authors have claimed that very many non-toxic nodular goiters are malignant and have recommended immediate thyroidectomy in all cases. It is here pointed out that nontoxic nodular goiter is a fairly common finding (at least 30,000 palpable goiters per million of population) while thyroid cancer is rare (only 25 cases diagnosed per million of population per year). There is evidence that surgical removal of all nodular goiters would result in more loss of life than could be justified by the resultant decrease in mortality from thyroid cancer. Emphasis today should be on the differential diagnosis of the thyroid nodule, with prompt operation in cases where the probability of malignancy is high and conservative treatment otherwise.