The simultaneous occurrence of hyperthyroidism and differentiated carcinoma of the thyroid gland is more frequent than previously assumed. In our endemic goiter region 16.5% of patients with thyroid carcinoma have hyperthyroidism and 1.8% of patients with hyperthyroidism have a thyroid carcinoma. The tumors are predominantly located in autonomous adenomas but are also found in cold nodules. Not only scintigraphically cold nodules but also warm and hot nodules must be suspected of malignancy. Consistent preoperative cytodiagnosis of all goiter nodules, including hot nodules, is therefore recommended. Surgical treatment of toxic multi-nodular goiters should be considered more often.

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