This is a study of the symptoms and signs of a condition found in about 1 in 50,000 of the community. It is of insidious onset and extended life history. It enters into the differential diagnosis of cancer of the lung but justifies a far better prognosis.
Embryologically, the thyroid gland is derived from the pharynx. In the course of numerous consultations and 325 biopsies and tracheal decompressions I have met with 7 cases in which goiters were not palpable in the neck, but were occult and intrathoracic. Of these one was inoperable. I operated on six successfully, and the patients survived. To operate regularly in the neck is essential if one is to perform major operations such as laryngectomy.
From the patients' point of view, the best person to perform such operations is whoever has the most intimate knowledge of the course of the recurrent laryngeal nerves, has the