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Although the indications for surgical therapy are quite definite and generally agreed to in toxic diffuse goiter, the indications are less clear and urgent in nontoxic nodular goiter. Nevertheless it is well known that nontoxic nodular goiter may develop toxicity or be the site of carcinoma, although the incidence of these changes is not fully realized nor are the dangers appreciated. A study of patients in our clinic with carcinoma of the thyroid and nontoxic nodular goiter has convinced us that numerous complications (including particularly the two just mentioned) developing in this type of goiter may make surgical therapy quite urgent in this seemingly harmless lesion. TYPES OF COMPLICATIONS RESULTING FROM NONTOXIC NODULAR GOITER1. Carcinoma.— It is now agreed that carcinoma of the thyroid gland arises in adenomatous growths in the majority of instances; some workers make the rather dogmatic statement that 80 to 85 per cent
Warren H. Cole (Sat,) studied this question.