In a consecutive series of 172 patients with Graves' disease treated by total thyroidectomy, 15 patients (9%) had an associated unsuspected carcinoma. There were 20 patients who had received prior treatment with radioactive iodine; 3 (15%) had carcinoma. The high incidence of thyroid carcinoma found in this series suggests that when surgery is elected as the treatment of choice in any given case of Graves' disease, nothing less than a total thyroidectomy should be performed. This high incidence would further indicate that surgery should be given even greater consideration in the selection of a modality for the management of any specific case of Graves' disease.

A series of 1,000 consecutive thyroid operations is presented, without a case of permanent recurrent laryngeal nerve injury. Emphasis is placed on the identification of variations and complete dissection of the recurrent laryngeal nerve, including peripheral branches and technical aspects of the dissection. Sixty-five percent of the cases had multiple terminal branches of the recurrent laryngeal nerve and five cases on the right side had a nonrecurrent course. A low incidence of hypoparathyroidism is presented, due in part to the avoidance of ligating the inferior thyroid artery in continuity and the technique of extracapsular dissection of the thyroid gland. The external branch of the superior laryngeal nerve was protected by the early mobilization of the superior thyroid vessels and ligatures placed flush on the capsule of the superior pole.

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Eighteen euthyroid patients with progressive malignant exophthalmos, of whom 16 had been treated by other forms of therapy, were treated with large therapeutic doses of radioactive iodine in an effort to ablate their thyroid glands. In four of the patients no functioning thyroid tissue could be demonstrated; in the others thyroid tissue can still be demonstrated with 5 mc doses of 131I preceded by thyrotrophin. In all patients, marked improvement of the infiltrative changes of ophthalmopathy resulted. Proptosis improved but in none of them did it regress completely to normal. The doses of radioactive iodine required to destroy thyroid remnants were much larger than the doses employed in the treatment of hyperthyroidism. It is suggested that the thyroid gland plays an important part in the complex problem of progressive exophthalmos and the presence of LATS, although its precise role remains to be determined.

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