Tumours in Iceland. 11. Malignant tumours of the thyroid gland. A histological classification and epidemiological considerations

All malignant primary tumours of the thyroid gland submitted for histological diagnosis in Iceland during the 30 years 1955-1984, and available for review, were typed histologically according to the World Health Organization classification but also taking into account the more recent well recognized follicular varient of papillary carcinoma. A total of 480 thyroid tumours were classified with a female - to male ratio of 2.8 (367 females, 129 males). The age distribution is much what would be expected, the anaplastic type of carcinomas occurring in the elderly while papillary and follicular tumours occur over a much wider age range. The incidence of thyroid carcinomas in Iceland is about 2-3 times higher than in the other Nordic countries. This is largely due to an unusually high incidence of the papillary type of carcinoma. Overall, the papillary carcinoma accounted for 80% of thyroid malignancies. The tumours diagnosed incidentally at autopsy were about 20% of the entire material, and these tumours were only of the differentiated types of thyroid carcinoma. Even if the incidentally diagnosed tumours are excluded, the percentage of papillary tumours is 77% which is unusually high. The papillary type of carcinomas occasionally occurred in familial clusters in Iceland but not sufficiently to account for the unusually high incidence. Some of the possible etiological factors are discussed.