Prognosis and Treatment of Malignant Goiter


In a discussion of the prognosis and treatment of malignant goiter it is not pertinent to offer any historical account of the literaure pertaining to this subject. In order, however, that the problem may be clearly understood, it is necessary to review the classifications of malignant tumors of the thyroid gland. Although I am fully cognizant of the widely diverging opinions regarding a satisfactory classification of these tumors, I shall present briefly Graham’s classification,1 since it is the one with which I am most familiar and my ideas about treatment and prognosis have been based on such a grouping of the cases.

Graham’s classification is as follows:

I. Sarcoma1. Lymphosarcoma
2. Spindle-cell sarcoma
II. Mixed3. Carcinoma-sarcoma
III. Carcinoma4. Scirrhous carcinomanot in adenomata
5. Adenocarcinoma
6. Papillary carcinomain adenomata
7. Malignant adenoma

These various groups may be briefly described as follows:

Lymphosarcoma probably originates in the lymphoid tissue of the thyroid gland. It is a hard, rapidly growing tumor, terminating fatally, usually within a period of months, and in our experience has resisted every type of therapy.

Spindle-cell sarcoma is of infrequent occurrence, and here again in our experience the prognosis is universally fatal. I cannot enter here into any discussion as to whether a true sarcoma may occur within the thyroid gland, but certainly tumors of this type cannot be distinguished from the spindle-cell sarcomata and fibrosarcomata which arise elsewhere in the body. Thyroid tumors of this type are usually recognized clinically as malignant.

It. . .