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The frequency distribution of immunogenic and non-immunogenic hyperthyroidism (IH, NIH) was evaluated retrospectively in the former endemic goiter area of Berne over a 15-year period (1976, 1982, and 1991). Out of 12,320 patients referred for thyroid examinations, 9.1% were hyperthyroid. NIH still predominates with a constant frequency of 59%; but the ratio between toxic adenomas (TA) and multifocal functional autonomies (MFA) was significantly inversed, from 2.6 over 0.9 to 0.4. The frequency of TA decreased from 41% to 17% and that of MFA increased from 16% to 38%. The arithmetic mean age at diagnosis was constant: 53.9 (IH), 61.5 (TA) and 67.5 years (MFA). The decreasing frequency of TA over the last 15 years is explained by an increased but still insufficient iodine supply.

In 1980 the iodide content of salt was increased in Switzerland from 7.5 to 15 mg/kg. This raised the mean urinary iodine excretion from 90 (indicating mild iodine deficiency) to 150 micrograms/g creatinine. We examined whether this public health measure was followed by a change of the incidence of hyperthyroidism in a defined catchment area of 109,000 persons. Except for a 27% rise in the first year of the new salt, the total incidence of hyperthyroidism declined steadily to reach 44% of the control level in 1988/89. This was due to a decrease mostly of toxic nodular goitre (minus 73%), less so of Graves' disease (minus 33%). We conclude that correction of mild iodine deficiency has beneficial effects on the incidence of hyperthyroidism, contrary to what is seen initially after correction of severe deficiency.

We evaluated the prevalence of antithyroid peroxidase antibodies (anti-TP0 Ab) in 402 patients with thyroid disease and 30 healthy controls by a commercial radioimmunoassay (RIA) and compared the results with the passive hemagglutination (HA) method. The patients in the study had autoimmune thyroid disorders (AITD) such as Graves' disease and Hashimoto's disease or had nonautoimmune thyroid diseases (NAITD) such as thyroid cancer, congenital goiter, endemic goiter, and nodular goiter. Subjects were recruited from a population with a mild iodine deficiency (Sao Paulo, Brazil). The effect of specific therapy (for either thyrotoxicosis or chronic thyroiditis) on the circulating anti-TPO levels was also investigated. Positive anti-TPO Ab was detected in 89.9% of the patients with AITD as compared with a prevalence of positive tests of only 4.8% in patients with NAITD. Positive microsomal antibody (M Ab) was found in 68.4% of the patients with AITD and in 6.4% of the patients with NAITD. A positive and significant correlation was obtained between M Ab and anti-TPO Ab. A positive anti-TPO test with negative anti-M was found in 14.1% of the patients with AITD but in only 4.3% of the patients with NAITD and normal controls. These results suggest that anti-TPO Ab by RIA is more sensitive and specific than M Ab by HA. In patients with AITD, anti-TPO Ab levels usually decreased after treatment, suggesting that this parameter could be used in the follow-up of these thyroid disorders.

Representatives of indigenous northern peoples (the Evenks and the Kets) living in a large Siberian territory named Evenkia were studied. There were children 6-14 years of age and adults aged 18-45 years. Thyroid volumes were determined by ultrasound. Iodine excretion was estimated. Normal thyroid volumes were found in 27.5% of the children. A high prevalence of goitre was detected in the adults. 55.4% of the women and 29.1% of the men had thyroid volumes above normal upper limits. Nodular goitres were found in 10.8% of the adults. 58.8% of the subjects had urinary iodine excretion below 10 micrograms/dl. Data show that the territory of Evenkia, settled by northern aborigines, is iodine deficient. The usage of the iodinated salt is ineffective. The preservation of the iodine content in salt remains the main problem in this area. In addition, some other goitrogenic agents may contribute to the high goitre prevalence in the indigenous population in Evenkia.

Over a period of 3 years, 614 patients were admitted to the General Surgery Department at the Riyadh Central Hospital with thyroid enlargements. Based on the clinical examination and non-invasive investigations, the thyroid swellings were classified into solitary nodule (45%), multinodular (44%) and diffuse goitre (11%). Subsequent classification of the goitres on the basis of intraoperative findings and histopathological examination revealed increase in the number of multinodular goitres to 70% while the solitary nodule and diffuse goitres dropped to 24% and 6%, respectively. Malignant changes were seen in 10% of the multinodular goitres after pathological examination. 75% of the carcinomas seen in multinodular goitres were of the papillary type. In almost none of the cases, it was possible to discover the malignancy preoperatively. The study recommends surgical intervention in all nodules goitres irrespective of being solitary or multinodular.

In a group of 38 pregnant women with primary, uni- or multinodular non-toxic endemic goitre, who were clinically euthyroid, 7.8% (3 cases) had previously undergone strumectomy for benign pathologies of the goitre and 10.5% (4 cases) received L-thyroxine therapy during pregnancy at a dose of 50 or 100 micrograms/day; during the course of pregnancy goitre was asymptomatic in 37 women (97.4%) and an endocystic hemorrhage occurred in 1 (2.6%) case. The goitre increased in volume in 42.1% (16 cases) of pregnant women monitored to term. Out of 20 patients undergoing ELISA of hormonal levels, 6 (30%) revealed TSH concentration more than twice the maximum normal value with normal concentrations of other thyroid hormones. There was a significant inverse correlation (r = 0.525) between T4 and TSH. Birth at term occurred at 39.9 +/- 2.6 weeks and was spontaneous in 78.9% of cases (30 cases) and laparotomic in 21.1% (8 cases). Perinatal pathologies included: 1 case (2.6%) of endo-uterine fetal death, 1 case of oligoamnios and 1 of IUGR. Funicular pathologies were observed in 13.1% of patients (5 cases). The Apgar index was > 8 in the 37 live births. The mean weight of male and female neonates and neonates from nulliparas and pluriparas was within the norm. When the data examined were compared to the results of the control group it was seen that there were no statistically significant differences.

We conducted a 6-year study of 110 patients with thyroid nodular disease in a previously goitrogenic area. The aim of the present work was to establish its incidence, to determine if multinodular goiter and autonomous thyroid nodule have the same analytical and clinical behaviour and to verify if the iodation campaign had resulted in the development of thyrotoxicosis induced by iodine. The results demonstrated an incidence of 0.4 per 1,000 population and per year. The two modalities of thyroid nodular disease did not present any clinical and analytical differences. 58.2% of the patients had hyperthyroidism, 53.1% of which were T-4 thyrotoxicosis, 12.5% T-3 thyrotoxicosis and 34.4%, subclinical hyperthyroidism. 8.2% of the patients under study had hyperthyroidism induced by iodine (Jod Basedow), with iodide excretion values higher that 3 standard deviations with respect to the population average (> 220 micrograms/g creatinine).

In order to relate the clinical expression of Graves' disease and Plummer's disease to age and thyroid hormone level, we prospectively studied 39 patients with Graves' disease and 26 patients with Plummer's disease using a standardized clinical score. Multiple regression analyses were performed with the clinical score as dependent variable and FT4I, age and diagnosis as independent variables. Our results show that patients with Graves' disease tend to have more signs and symptoms than patients with Plummer's disease. In addition, we found a positive correlation between the clinical score and FT4I. We did not find an age dependence of the clinical score, after controlling for diagnosis and FT4I. The age dependence reported by other authors is mainly due to the higher prevalence of Graves' disease among younger age groups in contrast to Plummer's disease.

Purpose of the paper: Specify the merits of ultrasonography in thyroid pathology. Outline ultrasonographic orienting criteria to identify the nature of thyroid nodules. Analysis of the paper: Thyroid ultrasonography allows detecting nodules that cannot be detected clinically or with radionuclide scanning. 20% of sonographic nodules cannot be palpated; 33% of sonographic nodules are not visible on radionuclide scans. Ultrasonography often shows multiple nodules where palpation and/or radionuclide scanning detect only one. When there are clinical signs of hyperthyroidism and uncertain biological findings, ultrasonography can relate a low-uptake nodule with an adenoma becoming autonomous, if the nodule appears to be hypodense. It allows monitoring the volume of nodules under freination therapy. Benign nodules may be liquid (15.7% of all cases); solid and isoechogenic (27.6%); solid and hyperechogenic (10.1%); solid and hypoechogenic (18.1%, including 88.5% toxic adenomas) or compound (26.4%). Comparison of the 2 series of nodules reveals the predominance of liquid and iso/hyperechogenic solid appearances for benign nodules (63.8%, excluding toxic adenomas). For cancers, the frequency of hypodense solid or compound nodules is 92.2%. Combining radionuclide scanning and ultrasonography allows further restricting the group of suspicious nodules, which have a low uptake and are hypodense or compound.

The results of surgical treatment of various forms of diseases of the thyroid gland in 254 children are analysed in follow-up periods of 12 months to 20 years. Functional compensation of the thyroid occurred in all patients with nodular forms of goiter who were subjected to operation which did not exceed hemithyroidectomy in volume. The analysis showed that operative treatment of children with the diffuse toxic form of goiter attended by the autoimmune component lead to hypothyroidism in 76.6% of patients, whatever the activity of the thyroid tissue, and a recurrence developed in 11.7% of those who were operated on. In children without the autoimmune component postoperative hypothyroidism was found in 48.6% of those examined, a recurrence was found in 3.2% of cases. The indications for operative treatment are specified, measures for the prevention of postoperative complications are listed.

The article characterizes the mortality rates of nodular and mixed euthyroid goiter in the Ukraine Republic and discusses the results of surgical treatment of 681 patients with various forms of goiter. In view of the double increase of the number of cases of thyroid carcinoma in the last 4 years, the authors suggest resecting the thyroid gland more extensively than in the previously conducted economical resections. Radioimmunological study of the thyroid hormones and thyrotropin in dynamics showed activation of hypophyseal +thyrotropic function after the operation. The authors, therefore, recommend using thyroidin without fail. Postoperative recurrences-1.5%, stable hypothyroidism-1.8%.

The thyroxin-binding globulin (TBG) polymorphism was investigated in three African groups: two belonged to the Bwa villages of Mali, and the third was a Dogon group living in the same area. The Bwa groups were characterized by the occurrence of nodular goitres, whereas the Dogon population did not show similar pathological symptoms. Females were more affected by goitre than males in the affected villages. The TBG polymorphism enabled us to demonstrate the presence of an undescribed allele (TBG C1) in these populations. The frequency of the TBG S allele was also higher than previously published in other African groups. We observed a disequilibrium in the distribution of the C and S alleles in the population, with an excess of homozygous TBG S individuals. No clear relationship between the TBG polymorphism and the number of nodules can be drawn.

The study was aimed at the evaluation of incidence of goiter in the population of the community of Sejny. The survey comprising 1520 subjects revealed the presence of thyroid enlargement in 31.8% of the subjects studied, indicating the occurrence of a mild endemy. The facts speaking for this type of endemy are: predominance of cases with goiter of OB or I degree (83%), higher incidence of goiter in women than in men (3.3 times), occurrence of nodular goiter in 12% of cases with goiter, and sporadic appearance of hypothyroidism. Goiter endemy in the population of this area can be attributed to such goitrogenic factors as low level of iodine and high content of calcium in the water, tobacco smoking, and a habit of drinking tap water.

The data on incidence of goiter in inhabitants of Kiev province for 5 years after Chernobyl accident, increase in number of operations performed for nodular forms of autoimmune thyroiditis and thyroid cancer are presented.

The authors discuss their experience in treating 815 patients who underwent an operation for nodular euthyroid and toxic goiter. Thermography was used in the examination of 367 patients and the results were compared with those of radioisotope scanning of the thyroid, intraoperative findings, and the results of histological study. It was established that in complex with clinical methods of examination, thermography is very important in making the differential diagnosis of thyroid diseases. The specific features of surgical tactics in patients with nodular goiter are shown. Economical resection of the gland together with the node is recommended in nodular euthyroid goiter and subtotal subfascial resection of the involved lobe or the thyroid gland in nodular toxic goiter.

Since the incidence of cancer in nontoxic nodular goiter as reported by us in 1944 appeared high (17.1%), we made another study during the next four years and discovered an incidence almost identical (17.2%). Our figures on incidence of cancer in nontoxic nodular goiter appeared so high because we were the first authors to break down the goiters into the three different types and to discover that the incidence was high in only one type of goiter and not in the others. The incidence of cancer was only 4.6% in toxic nodular and toxic diffuse goiter added together. For decades, we have known that goiter is a geographic disease. It is possible that carcinoma of the thyroid is slightly geographical. At least it appears that there is a slightly geographical relationship in regard to the 16 patients we have observed in our clinic with cancer during 1944-1949; of these 16 patients, 11 had advanced malignant disease. We cannot have accurate figures on results regarding treatment of our cases until long-term follow-up is concluded.

A comparative analysis of 2419 case histories of patients operated on for different thyroid diseases, has shown that the frequency of adenocarcinomas in lymphadenoid goiter is almost like in nodular and multinodular goiter however they are detected usually in the form of microfoci. Thyroid cancer in patients with lymphadenoid goiter combined with nodular goiter and/or adenoma is detected twice as more frequently than in patients with (multi)nodular goiter. Routine methods of investigation do not permit preoperative detection of malignancy against a background of lymphadenoid goiter.

In a 3-year (1983-1985) epidemiological study of thyrotoxicosis in North Canterbury, New Zealand, the annual incidence was 25.8 per 100,000 (female 40.7, male 10.5). Thyroid scintiscanning showed that 64% had diffuse hyperplasia (DH), 27% toxic multinodular goitre (TMG), 7% toxic uninodular goitre (TUG), and 2% zero uptake. The calculated annual incidence of toxic diffuse goitre (DH) was 15 per 100,000, and for toxic nodular goitre (TMG and TUG combined) was 8 per 100,000. The age-related incidence for toxic diffuse goitre peaked in middle life whereas toxic nodular goitre showed an increasing incidence with age. There was no significant seasonal variation or rural/urban difference in incidence. Analysis of geocoded addresses did not identify areas of high incidence. The variable duration of symptoms prior to diagnosis limits the search for possible environmental trigger factors. North Canterbury was an endemic goitre area prior to the introduction of iodized salt 50 years ago, and the incidence of toxic nodular goitre is likely to fall in future.

Fourty cases of thyrotoxicosis seen over a 5-year period in the endocrinology service of a teaching hospital in Ibadan, Nigeria have been reviewed. The clinical manifestations are not different in any way from the pattern described in other parts of the world and there was a female preponderance in a ratio of 4:1. The ratio of diffuse toxic goiter to toxic multinodular goiter was only 3:2, underscoring the relative uncommonness of Grave's disease, an autoimmune disorder, in Nigerian Africans. The study also demonstrated an increase in the hospital prevalence of thyrotoxicosis in Ibadan in the last 10-15 years; however, the incidence rate of 8 cases per year is still low when compared to experiences in other parts of the world. The presence of a goiter, ocular changes, high sleeping pulse rate, fine silky-smooth skin and thin, short and scanty hair have been identified as important clinical clues to look for to aid in the diagnosis of a difficult case in an environment where there are no facilities for thyroid function tests. Surgery was the most dependable form of treatment because of the cost and scarcity of drugs and complete absence of radiotherapy.

A population study showed a prevalence of 2.8% for nontoxic goitres. The clinical significance of non-toxic goitres were not previously defined. This study examined 64 patients with non-toxic goitres which were classified clinically as diffuse (gp1), lobular (gp2) and nodular (gp3). They were studied in terms of thyroid antibodies, radioisotope scanning, ultrasonography and fine-needle aspiration cytology. The goitres were mainly nodular (69%), the rest were diffuse and lobular in equal numbers. Seventy percent of the nodular goitres had 1 nodule. One case of diffuse goitre and half the lobular goitres had multinodularity demonstrated on imaging. Antithyroid antibodies were detected in 20% of gp2, 7% of gp3 and none in gp1. Malignancy was found in 2% of gp2, 11% of gp3 and nil in gp1. A management strategy for non-toxic goitre was discussed.

Four hundred and sixty-seven new cases of thyrotoxicosis were diagnosed during the period 1975-1984 in a demographically well defined Swedish inland county, with about 134,000 inhabitants, where goitre has been considered endemic. This corresponds to a mean annual incidence of all thyrotoxicosis of 34.7/100,000. The mean incidence of toxic diffuse goitre was 16.6/100,000 and of toxic nodular goitre 18.4/100,000. The mean incidence of all thyrotoxicosis fell from 39.2 to 30.2/100,000/year between the first and the second 5-year period of the study (P less than 0.01); this was entirely due to a decrease in the incidence of toxic nodular goitre (22.6 to 14.1/100,000/year) whereas the incidence of toxic diffuse goitre did not change significantly. The decrease in the incidence of toxic nodular goitre was evenly distributed over all age groups and over rural and urban areas of the county.

Of 287 consecutive patients, surgically treated at our department for benign, nontoxic goitre during a six-year period, 261 could be followed up, on average, 8.0 years postoperatively. Unilateral surgical procedures had been used in 199 patients, subtotal thyroidectomy in 62. 29 patients were treated with thyroxine (T4) immediately postoperatively ("recurrence prophylaxis"); in the other patients thyroxine was only given in cases of hypothyroidism (significant increase of s-TSH). 26 patients had a goitre recurrence 0.5-10 years after surgery; of these 3 had got T4 as "recurrence prophylaxis" and 23 had not. There was no significant difference between patients with and without T4 postoperatively regarding the rate of recurrence. Of 55 patients treated with subtotal thyroidectomy, 33 had postoperative latent (n = 26) or manifest (n = 7) hypothyroidism. Only 13 of 177 patients operated on unilaterally developed hypothyroidism; two of these had Hashimoto's thyroiditis. All cases of hypothyreosis except 4 were detected within the first 12 months of follow-up. This study indicates that routine use of thyroxine as prophylaxis against recurrence after surgery for benign nontoxic goitre can be strongly questioned and that the risk of hypothyroidism is high after subtotal thyroidectomy.

During a 5-year period, 333 new cases of thyrotoxicosis were diagnosed in a well-defined urban population of 258,000 inhabitants in southern Sweden without a history of endemic goitre. This corresponds to a mean annual incidence of thyrotoxicosis of 25.8/100,000. The incidence of Graves' disease was 17.7, the incidence of toxic nodular goitre was 5.4 and that of solitary toxic adenoma was 2.7/100,000/year. The peak age-specific incidence of Graves' disease was 32.6/100,000/year (age group 60-69 years), and that of toxic nodular goitre and solitary toxic adenoma was 31.5/100,000/year (age group over 80 years).

We analyzed 33 patients with recurring nodular goiter (from a population of 2,500 operated patients). Recurrence occurred 0.7 to 12 years after surgery. T4, T3, TSH, perchlorate and TRH tests were performed in 18. Results were similar to those in 13 operated patients without recurrence. Administration of thyroid hormone did not influence recurrence. Seven patients with recurring goiter were re-operated on; an encapsulated follicular cancer was found in one. Our results suggest that recurrence of nodular goiter after surgery is not prevented by routine use of thyroid hormone.

Altogether 252 case records of patients operated on for thyroid cancer were analyzed to determine the frequency of combination of a neoplastic process with autoimmune thyroiditis. Analysis of morphological findings of the operative material has shown that thyroid cancer in autoimmune thyroiditis occurs 2.5-times less than in adenomatous goiter and 1.5-times less in diffuse toxic goiter. The resultant conclusion is that the combination of thyroid cancer with autoimmune thyroiditis occurs more seldom than cancer with diffuse toxic goiter and adenomatous goiter, and the combination of autoimmune thyroiditis with diffuse toxic goiter and adenomatous goiter occurs more frequently than that with thyroid cancer.

The incidence of thyrotoxicosis was determined in a collaborative study in 12 towns in England and Wales. Cases were ascertained prospectively through biochemistry laboratories carrying out routine thyroid function tests. The annual incidence varied from 9.7 to 49.2 per 100 000. Reassay of sera at a reference laboratory showed that this variation did not result from inter-laboratory differences in the techniques for measuring thyroid function. The incidence of thyrotoxicosis was strongly correlated with the previous prevalence of endemic goitre in the towns. Current high dietary intakes of iodine--largely the result of milk contamination--may cause toxic nodular goitre in people made susceptible by a lack of iodine early in life. They may also contribute to the occurrence of Graves' disease.

A retrospective investigation of the surgical cases of seven hospitals in the Veneto region was made in order to assess the malignancy rate in thyroid nodular pathology, and the predictive value of scintiscanning with positive indicator.

Endemic goitre of moderate severity was mainly found in the East of Finland still in the 1950s but the whole country was moderately iodine deficient. The daily iodine intake determined both from food consumption and from the urinary excretion in population samples was 50-70 micrograms being lower in the East. The main iodine sources were milk products, about 50% of the daily intake being derived from these. Iodized salt was available but its use was very low and the iodine content insufficient so that only about 20% came from this source. In the late 1950s iodine prophylaxis was activated and since then only salt containing 25 mg KI/kg has been imported. However, during the last decades the consumption of salt has declined from 7-8 g to less than 4 g per day. Today the iodine intake in Finland is about 300 micrograms per day, the highest in Europe. The main sources are milk products and eggs which provide about 2/3 of the daily iodine intake due to an active iodine prophylaxis of house animals and only 20% comes from iodized salt. The origin of endemic goitre in Finland has obviously been multifactorial autoimmunity, natural goitrogens and possibly genetic factors being superimposed upon the basic iodine deficiency. The iodine supply is now adequate and there is no more goitre in neonates and no endemic goitre in school children in whom the prevalence is usually below 1%. Concomitantly, the nosology of hyperthyroidism has changed. Whereas more than 80% of hyperthyroid patients in the 1950s had nodular goitre the main type of hyperthyroidism today is Graves' disease proper with a small or normal-sized thyroid gland without nodules obviously due to disappearance of the endemic nodular goitre.

Toxic nodular goitre is the late result of a slow growth process generating new daughter follicles from the mother follicles of a normal thyroid gland. Since the normal follicular shell is not built up by monoclonal epithelial cells, but rather by cells with widely variable functional equipment, daughter follicles generated by the preferential replication of particular mother follicular cells endowed with a high growth potential, may be different from mother follicles. For instance, the progeny of follicles may have a higher or lower iodine metabolism than their progenitor follicles. Some of the newly generated follicles have a high autonomous, i.e. TSH-independent, iodine turnover, while some others have a high autonomous growth potential. The degree of autonomous function is entirely independent of that of growth. In the process of goitrogenesis, newly generated follicles may, in addition, acquire new forms of expressing genetic functions. Such new traits, e.g. a particular growth pattern, may become inheritable and are then passed on from mother to daughter cells. The result is the most characteristic of all hallmarks of nodular goitres, which is the heterogeneity of structure and function between two diseased glands and even between closely adjacent follicles of the same gland. Greatly uneven intrinsic replication rates between different follicular cells and equally varying independency on growth stimuli account for regional differences in goitre growth. This, together with a network of fibrous scars interfering with unimpeded expansion of the growing follicle population, invariably produces a nodular growth pattern of the goitre. TSH certainly does not account for the growth of this type of goitre. Instead, a number of thyroid growth factors, including growth-stimulating immunoglobulins akin to those found in Graves' disease, have been discovered in recent years. Once the number of follicular cells with high intrinsic growth potential has become large enough under the impact of extrathyroidal growth stimuli, goitre growth may become autonomous and self-perpetuating. Whether or not a nodular goitre will produce thyrotoxicosis is a function of the number of follicles with high intrinsic iodine turnover which happen to be generated in the course of goitrogenesis. In contrast to thyrotoxicosis in Graves' disease, hyperthyroidism in nodular goitre is a very slowly progressing, insidiously evolving complication.

Based on the experience acquired in the treatment of 500 patients with thyroid affections, of which 229 had benign nodular goiters and 12 had degenerated nodular goiters, the authors stress the necessity of very detailed preoperative exploration, that are capable to provide a series of essential elements for establishing the indication for surgery. Clinical exploration is also a significant contribution, as well as the peroperative exploration, including the histologic one. The trend is noted, as a result of exploration capabilities, and of improved pre- and postoperative treatment possibilities, to perform extensive, and even total resections.

An epidemiological study involving 616 subjects carried out in the Man region, Côte-d'Ivoire, showed endemic goitre in 54,4% of the group overall and in 80 % of females. Thyroid function of subjects chosen at random in the goitrous and nongoitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher, which represents a high TBG level with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (--0,40) but the T3-TSH correlation for the G subjects was significantly lower (--0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently encountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.

Seventy carcinomas of the thyroid gland were found in 1300 thyroidectomies for an incidence of 5.4%. The incidence of malignancy in single nodules was 9.7% and in multinodular nontoxic goiter 4.3%. The risk of cancer was higher (14.2%) in males than in females (4.3%). The highest incidence of cancer was found in children under the age of 10 (40%). Radioactive iodine scintiscanning was of limited help in differentiating benign from malignant nodules. Early surgery is advised for all patients with single thyroid nodules and all thyroid nodules in children should be excised.

One hundred consecutive patients were studied at the Auckland Hospital thyroid clinic over a two year period 1974 to 1976, who subsequently had surgical excision of a solitary cold nodule. Thyroid carcinoma was present in 17 percent, adenoma in 44 percent, colloid nodules in 25 percent and a thyroid cyst in 14 percent. Although thyroid neoplasms were significantly more frequent in patients under 40, other clinical or scan features analysed were not predictive of carcinoma or neoplasm.

The basic features of the most common endocrine pathology, the thyroid nodule are analysed. After a brief assessment of the incidence of the condition the problem of clinical and instrumental diagnosis is tackled with the aim of demonstrating the value and possibility of sub-clinical diagnosis of micronodules. The present work aims to identify the fastest, most efficient and cheapest diagnostic procedure.

After 30 years of iodine prophylaxis the incidence of goiter in the Valea Jiului area was reassessed. A number of 7,892 pupils aged 7-16 years were examined, of whom goiter was found in 32%. Before iodine prophylaxis started the incidence was 91.8%. The present survey shows that the small-sized goiters markedly prevail over middle-sized ones, while large-sized goiters became extinct. The diffuse to nodular goiter ratio changed by the disappearance of the nodular forms. The neurologic and psychic complications in goiter-bearing children disappeared. Attempts to correlate taste sensitivity to thiocarbamide with goiter failed. Examination of the digito-palmar dermatoglyphics showed a greater incidence of the higher atd angle, with transition forms of sulcus palmaris.

Of 5,179 school children surveyed in Utah, Nevada, and Arizona for thyroid abnormalities because of possible exposure to radiation from fallout, nodularity of the thyroid was found in 98 (1.8%). In 34, the nodularity represented lobulation associated with adolescent goiter, and in 31, thyroiditis. Two malignant neoplasms were found. In a normal childhood population in which nodularity is incidentally discovered on physical examination, the risk of nodularity being malignant is approximately 2%. Factors that favor exploration of thyroid nodules in children are discreteness, growth of the mass, singleness, and absence of other thyroid disease.

From January 1962 through October 1975, 455 patients with single thyroid nodules were operated on at King Paul Hospital. Malignancy was proved in forty-three patients. The overall incidence of carcinoma was 9.5 per cent. A higher incidence of cancer was found in patients less than ten years of age (40 per cent), between eleven and twenty years of age (20 per cent), and more than sixty-one years of age (17.4 per cent). Malignant nodules were more frequent in males (17.5 per cent) than in females (8.3 per cent). Radioactive iodine scanning does not distinguish benign from malignant nodule. Solitary thyroid nodules require operative excision supplemented with replacement therapy.

Taste sensitivity to phenylthiocarbamide is thought to reflect a genotype homozygous for a single recessive gene. European and North American populations show a mean non-taster frequency of about 30% whereas Mongoloid populations show a much lower frequency of non-tasters. In the present study of Nigerians, there were mean non-taster frequencies of 1.9-2.9% among healthy subjects and not a significantly different level, 3.5%, among goitrous ones. Among subjects with nodular goiter, however, the non-taster frequency was 18.7%, significantly higher. The results suggest that there is a rarity of non-tasters among Nigerians and that non-tasters are more susceptible to the development of nodular goiter than are tasters.

A prospective study involving 1,544 patients who had annual physical examinations during a one-year period was conducted to determine the incidence of htyroid abnormalities in a practice of general internal medicine. A total of 5.8% abnormalities were found including nodular disease, thyroiditis, Graves' disease, hypothyroidism, simple goiter, and iatrogenic hyperthyroidism. No thyroid cancer was detected.