Twenty year's experience of thyroid cancer in a district general hospital has been reviewed. Its incidence, prognosis and natural history have been studied. Particular attention has been focused on the relationship of malignant to benign goitre. The relevance of this to the treatment of 'apparently benign goitre' is discussed. Clinical evidence is presented supporting the hypothesis that differentiated thyroid carcinoma evolves from a solitary focus through a multinodular form before presenting the picture of a frankly malignant locally invasive cancer. An increase in the incidence of papillary carcinoma is confirmed.

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