Annali italiani di chirurgia
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The incidence of thyroid carcinoma in hyperthyroidism varies considerably from as low as 0.3% to as high as 16.6% with a higher rate in toxic nodular goiters. Occult thyroid carcinoma (< 1.5 cm or microscopic foci) is the rule and only a few tumors are suspected preoperatively with ultrasonography or fine needle aspiration or 131 I scan. In 408 patients who underwent surgery for hyperthyroidism in our Surgery Department from January 1967 through December 1994 the incidence of thyroid carcinoma was 5.6% (23 cases). ⋯ Mean follow-up is 59.6 months. Our retrospective study shows a progressive increase of the incidence of coexisting thyroid malignancy and hyperthyroidism especially in toxic nodular goiter, probably related to extended surgical indications. Our findings do confirm that, even in the presence of hyperthyroidism, all thyroid nodules require careful diagnostics for exclusion of malignancy.
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The progress in surgery, anaesthesia, pre and postoperative care improves the number of old patients undergoing major surgery. The preoperative physiologic assessment is very important to identify patients who are at higher risk group and to plan the therapeutical strategics. ⋯ The authors emphasize that the preoperative physiologic assessment to identify patients at higher risk and an accurate preoperative care may reduce the mortality rate also in patients over 80 years undergoing major surgery. In urgency, when the patients cannot undergo a preoperative assessment and care, the postoperative mortality is higher in the group over 80 years than in younger.