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).
The total incidence of thyrotoxicosis, as well as the incidence of GD in females younger than 50 years and the incidence of TNG/STA in females of 50 years or older, has increased in Malmö during the period from 1970 to 1990. The increase was probably caused by several factors such as more sensitive diagnostic tools and GD changes in smoking habits, but additional unknown factors might also be of importance.
The incidence of recurrence and of hypothyroidism was determined in all new patients treated for thyrotoxicosis during the period 1970-1974 in an unselected, well-defined urban population. A total of 309 patients were followed up for a median time period of 108 (1-192) months. There was a cumulative incidence of 51% recurrence in patients who were treated with antithyroid drugs for Graves' thyrotoxicosis, whereas after surgery or radioiodine treatment there were few recurrences, but 32% and 78% cumulative incidences of hypothyroidism. There were no recurrences after surgery or radioiodine treatment in patients with toxic multinodular goitre or solitary toxic adenoma, but 29% and 40% cumulative incidences of hypothyroidism following radioiodine treatment. Late hypothyroidism occurred after surgery for Graves' thyrotoxicosis, and in all groups treated with radioiodine. Thus it is advisable that all patients with Graves' thyrotoxicosis, regardless of treatment, and all patients with toxic multinodular goitre or solitary toxic adenoma treated with radioiodine, should be followed up for many years, and probably for life.
We report a well-documented case of fatal thyroid cancer with histopathological characteristics of primary squamous carcinoma. A possible primary tumour elsewhere was excluded. The possible histogenesis of this unusual tumour and the therapy of choice are briefly discussed.
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