PURPOSE

The purpose of this paper is to summarize the experience of some of the major clinics in the United States relative to the frequency of carcinoma of the thyroid in association with nontoxic nodular goiter, and to present a series of cases from a large Army hospital. In addition, we shall attempt to point out the difficulty of interpreting the wealth of material now in print on the subject. The problem of whether the presence of symptoms would render the individual case more likely to have cancer, a facet which has received little attention in the literature, was carefully analyzed. MATERIAL The case records of all patients having the discharge diagnosis of non-toxic nodular goiter and carcinoma of the thyroid were reviewed for the five year period of 1950-1954, inclusive. All cases of carcinoma were found in association with nodular goiter, none in diffuse goiter. All cases must have had surgery to be included in the series, so that the exact pathologic diagnosis was known. The report of the Armed Forces Institute of Pathol-ogy was available in each case. It was realized at the onset that the series would be a selected group, because the records were those of in-patients who had been operated upon, and physician-screening had thereby occurred in the out-patient section, as well as on the in-patient service prior to referral to surgery. The patients in the series were all active or retired military personnel and their dependents. METHOD Each record was carefully analyzed and the patient placed in one of five groups, as follows: 1. Benign goiter without symptoms: patient hospitalized for another complaint. 2. Benign goiter without symptoms: found on routine physical examina-tion in the Outpatient Department