PubMed · 5634147
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F M Doménech-Torné, J Setoain Quinquer. [Gammagraphy in diffuse goiter].. https://pubmed.ncbi.nlm.nih.gov/5634147/
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A previous register linkage study showed an increased risk of thyroid cancer among patients previously discharged from a hospital with a diagnosis of a benign thyroid disorder. In this study, we have reviewed all available medical records, first to validate the earlier result and second to describe the symptomatology of patients with a history of benign thyroid disorder prior to the cancer diagnosis. The previous study identified 189 patients with a benign and subsequent malignant thyroid disorder. Medical records were obtainable for 156 of these patients and were reviewed. For 104 patients, benign and malignant thyroid diseases were metachronous (a clearly separated disease history of the benign and malignant diseases), and for 48 patients synchronous. In 4 cases, thyroid cancer could not be confirmed. Among patients with metachronous thyroid disorders, all major benign thyroid disorders were represented including hot nodules, diffuse and multinodular toxic and nontoxic goiter. Symptoms preceding diagnosis of thyroid cancer included growth of goiter/nodules, globulus, stridor, hoarseness, and metastasis. No major differences were found among patients with metachronous and synchronous benign and malignant thyroid disorder, apart from the fact that all metastases were found among metachronous cases. This study confirmed the conclusion that patients with a previous history of goiter or nodules have an increased risk of thyroid cancer. However, thyroid cancer still occurs too infrequently to warrant screening in all patients with a previous history of goiter or nodules.
This paper is an attempt to evaluate the role of diagnostic and therapeutic tools to define differentiated thyroid carcinoma. At the beginning of the last century, physicians described its clinical feature: hard and invasive goiter arising after 25 and leading to death. In 1860, the surgical revolution encouraged the surgeons of goiter to treat thyroid cancer: simple goiter was viewed as precancer. From 1880, cell and tumor theories led pathologists to define microscopically thyroid cancer. In 1920, they demonstrated that the two most constant indications of thyroid epithelial malignancy were invasion of the blood vessels and distant metastasis. In 1930, radiotherapists introduced the concept of prognostic classification which combines histological criteria and patient survival for thyroid cancer. From 1940, the medical use of radioiodine led to distinguish two groups of thyroid tumors: those which are able to concentrate radioiodine and those which are not. Physicians, specialised in thyroid endocrinology, established the rules of thyroid cancer treatment. Our purpose is to analyse the epistemological and historical context of this pathology definition.
Goiter is still a frequent pathological condition of the thyroid gland. Goiter consists of an enlargement of the gland caused by several physiopathologic events, the most important of which is deficient intake of iodine. A series of eighteenth-century mummies housed in the church of Santa Maria della Grazia in Comiso includes one individual showing a pathological condition, with a very large swelling in the antero-inferior region of the neck. X-rays showed small scattered radiopaque foci. Routine histology showed a large number of circular follicles immersed in fibrous tissue. Finally, immunohistochemistry revealed a strong reactivity for thyroglobulin. The data confirmed the nature of the tissue as thyroid, and the macroscopic diagnosis is that of thyroid goiter.