Thyroid surgery in an area of iodine deficiency.
BACKGROUND
The catchment area of the patients under study was the sub-Himalayan plains, which are recognized as iodine-deficient areas.


METHODS
A retrospective analysis of 1576 surgically treated patients with thyroid disorders is presented. The indications for surgery were hyperthyroidism or cytologically diagnosed malignancy and large size, pressure symptoms, cosmesis, suspicious cytologic findings for malignancy, and clinical suspicion of malignancy in clinically benign euthyroid goiters.


RESULTS
Histologically, 83 of 703 solitary thyroid nodules, 36 of 329 clinically benign euthyroid multinodular goiters, and four of 181 Graves' disease were cancers. Of all follicular cell cancers in this study, 132 were papillary, 83 were follicular, and 38 were anaplastic and squamous cell cancers. The different histologic types exhibited an aggressive clinical behavior, with advanced lesions with cervical lymph node involvement and distant metastases frequently seen at presentation. Locoregional recurrence occurred frequently even after radical surgical ablation, and overall mortality caused by the disease was high.


CONCLUSIONS
Even well-differentiated cancers pursued a virulent clinical course with high mortality, despite routine radical surgical and radionuclide ablation.
Sarda
Anil K
AK
Department of Surgery, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India. aksarda@rediffmail.com
Kapur
Man M
MM
D018263:Adenocarcinoma, Follicular / Q000453:epidemiology / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000453:epidemiology / Q000601:surgery; D000328:Adult; D002391:Catchment Area, Health; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007194:India / Q000453:epidemiology; D007455:Iodine / Q000172:deficiency*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D013972:Thyrotropin / Q000097:blood
D013972:Thyrotropin; D007455:Iodine