1.

1. The diagnostic features are the stony hard tumor, the immobility, the dyspnea from tracheal compression as shown by x-ray in the advanced cases out of proportion to the size of the tumor, the lack of toxic symptoms and of cervical node involvement.

2.

2. The treatment of choice is surgical, complete thyroidectomy, especially when both lobes are involved, and the case is operable. If not, at least a wedge-shaped piece should be removed from the isthmus to relieve the pressure over the trachea. The results of x-ray treatment have not been noteworthy and the data relative to such treatment are meager.

3.

3. Rectal anesthesia is preferable in these cases, avertin is the choice when fibrous extension has not passed the capsule and the prethyroid muscles and adjacent tissues are not involved, and the trachea not constricted. In the advanced cases with marked constriction of the trachea and involvement of adjacent tissues, oil-ether colonic anesthesia as developed by Gwathmey in the Stuyvesant Square Hospital, gives a prolonged anesthesia with a minimum of danger, and the surgeon can do a careful operation without worrying about the length of time he is taking. No doubt the mortality from operations on the earlier cases reported would have been lessened with this type of anesthesia.

4.

4. The pathology is that of a replacement fibrosis, of an earlier lymphoid cell invasion.

5.

5. While the mortality was rather high in the first cases reported and many cases were abandoned as inoperable, or a tracheotomy only was performed, it is noticeable in the later cases that the mortality has diminished to a practically negligible figure.

6.

6. Most of the writers who have either written articles or reported cases, with the exception of Hashimoto in 1912 and Graham and McCullough in 1931, have not chosen to separate the two types of strumas, Riedel's and Hashimoto's, but have considered them to be different stages of development of the same disease.