Skip to main content
Erschienen in: MMW - Fortschritte der Medizin 7/2019

15.04.2019 | Szintigrafie | FORTBILDUNG . ÜBERSICHT

Ein Zuviel und ein Zuwenig vermeiden

Zufallsbefund Schilddrüsenknoten: Wie geht es nun weiter?

verfasst von: PD. Dr. med. Roland Ladurner, Prof. Dr. med. Klaus Hallfeldt, Prof. Dr. med. Martin Angele, Prof. Dr. med. Jens Werner, Prof. Dr. med. Martin Reincke, Prof. Dr. med. Christine Spitzweg, Dr. med. Christian Lottspeich

Erschienen in: MMW - Fortschritte der Medizin | Ausgabe 7/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Durch den zunehmenden Einsatz der Schilddrüsensonografie werden immer mehr Schilddrüsenknoten diagnostiziert, die aber meist keiner Therapie bedürfen. Wie vermeiden Sie eine Überdiagnostik und -therapie, ohne behandlungsbedürftige Pathologien zu übersehen?
Literatur
1.
Zurück zum Zitat Meisinger C, Ittermann T, Wallaschofski H, Heier M, Below H, Kramer A, Doring A, Nauck M, Volzke H: Geographic variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany. Eur J Endocrinol 2012, 167(3):363–371.CrossRef Meisinger C, Ittermann T, Wallaschofski H, Heier M, Below H, Kramer A, Doring A, Nauck M, Volzke H: Geographic variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany. Eur J Endocrinol 2012, 167(3):363–371.CrossRef
2.
Zurück zum Zitat Fuhrer D: [Genetics of thyroid nodules and thyroid carcinoma]. Internist (Berl) 2018, 59(7):674–680.CrossRef Fuhrer D: [Genetics of thyroid nodules and thyroid carcinoma]. Internist (Berl) 2018, 59(7):674–680.CrossRef
3.
Zurück zum Zitat Gärtner R, Scheidhauer K, Negele T, C S: DePräopertive Diagnostik bei Struma nodosa. Manual Endokrine Tumoren by Tumorzentrum München (HRSG) Fürst H, Auernhammer CJ, Schiedhauer K, Spitzweg C, Vogelsang HW Zuckerschwerdt Verlag, München 2017:16–20. Gärtner R, Scheidhauer K, Negele T, C S: DePräopertive Diagnostik bei Struma nodosa. Manual Endokrine Tumoren by Tumorzentrum München (HRSG) Fürst H, Auernhammer CJ, Schiedhauer K, Spitzweg C, Vogelsang HW Zuckerschwerdt Verlag, München 2017:16–20.
4.
Zurück zum Zitat Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, Paschke R, Valcavi R, Vitti P, Nodules AAATFoT: American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules—2016 Update. Endocr Pract 2016, 22(5):622–639.PubMed Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedus L, Paschke R, Valcavi R, Vitti P, Nodules AAATFoT: American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules—2016 Update. Endocr Pract 2016, 22(5):622–639.PubMed
5.
Zurück zum Zitat Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H et al: [Update of the S2k guidelines: Surgical treatment of benign thyroid diseases]. Chirurg 2018, 89(9):699–709.CrossRef Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H et al: [Update of the S2k guidelines: Surgical treatment of benign thyroid diseases]. Chirurg 2018, 89(9):699–709.CrossRef
6.
Zurück zum Zitat Frank-Raue K, Schott M, Raue F, im Namen der Sektion Schilddruse der DGE: [Recommendation for Calcitonin Screening in Nodular Goiter]. Dtsch Med Wochenschr 2018, 143(15):1065–1069.CrossRef Frank-Raue K, Schott M, Raue F, im Namen der Sektion Schilddruse der DGE: [Recommendation for Calcitonin Screening in Nodular Goiter]. Dtsch Med Wochenschr 2018, 143(15):1065–1069.CrossRef
7.
Zurück zum Zitat Force USPST, Bibbins-Domingo K, Grossman DC, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW, Jr., Kemper AR, Krist AH et al: Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2017, 317(18):1882–1887.CrossRef Force USPST, Bibbins-Domingo K, Grossman DC, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW, Jr., Kemper AR, Krist AH et al: Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2017, 317(18):1882–1887.CrossRef
8.
Zurück zum Zitat Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L: Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med 2016, 375(7):614–617.CrossRef Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L: Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med 2016, 375(7):614–617.CrossRef
9.
Zurück zum Zitat Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D’Onofrio M, Drakonaki EE et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013, 34(2):169–184.CrossRef Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D’Onofrio M, Drakonaki EE et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013, 34(2):169–184.CrossRef
10.
Zurück zum Zitat Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH, Klauser AS, Sporea I, Calliada F, Cantisani V et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013, 34(3):238–253.CrossRef Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH, Klauser AS, Sporea I, Calliada F, Cantisani V et al: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013, 34(3):238–253.CrossRef
11.
Zurück zum Zitat Leenhardt L, Erdogan MF, Hegedus L, Mandel SJ, Paschke R, Rago T, Russ G: 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013, 2(3):147–159.CrossRef Leenhardt L, Erdogan MF, Hegedus L, Mandel SJ, Paschke R, Rago T, Russ G: 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013, 2(3):147–159.CrossRef
12.
Zurück zum Zitat Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, Callstrom M, Elraiyah TA, Prokop LJ, Stan MN et al: The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014, 99(4):1253–1263.CrossRef Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, Callstrom M, Elraiyah TA, Prokop LJ, Stan MN et al: The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014, 99(4):1253–1263.CrossRef
13.
Zurück zum Zitat Choi SH, Kim EK, Kwak JY, Kim MJ, Son EJ: Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Thyroid 2010, 20(2):167–172.CrossRef Choi SH, Kim EK, Kwak JY, Kim MJ, Son EJ: Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Thyroid 2010, 20(2):167–172.CrossRef
14.
Zurück zum Zitat Remonti LR, Kramer CK, Leitao CB, Pinto LC, Gross JL: Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015, 25(5):538–550.CrossRef Remonti LR, Kramer CK, Leitao CB, Pinto LC, Gross JL: Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015, 25(5):538–550.CrossRef
15.
Zurück zum Zitat Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS: New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002, 178(3):687–691.CrossRef Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS: New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002, 178(3):687–691.CrossRef
16.
Zurück zum Zitat Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M et al: 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016, 26(1):1–133.CrossRef Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M et al: 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016, 26(1):1–133.CrossRef
17.
Zurück zum Zitat Leboulleux S, Tuttle RM, Pacini F, Schlumberger M: Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016, 4 (11):933-942CrossRef Leboulleux S, Tuttle RM, Pacini F, Schlumberger M: Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016, 4 (11):933-942CrossRef
18.
Zurück zum Zitat Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M: An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009, 94(5):1748–1751.CrossRef Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, Dominguez M: An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009, 94(5):1748–1751.CrossRef
19.
Zurück zum Zitat Friedrich-Rust M, Meyer G, Dauth N, Berner C, Bogdanou D, Herrmann E, Zeuzem S, Bojunga J: Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules. PLoS One 2013, 8(10):e77927.CrossRef Friedrich-Rust M, Meyer G, Dauth N, Berner C, Bogdanou D, Herrmann E, Zeuzem S, Bojunga J: Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules. PLoS One 2013, 8(10):e77927.CrossRef
20.
Zurück zum Zitat Cheng SP, Lee JJ, Lin JL, Chuang SM, Chien MN, Liu CL: Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head Neck 2013, 35(4):541–547.CrossRef Cheng SP, Lee JJ, Lin JL, Chuang SM, Chien MN, Liu CL: Characterization of thyroid nodules using the proposed thyroid imaging reporting and data system (TI-RADS). Head Neck 2013, 35(4):541–547.CrossRef
21.
Zurück zum Zitat Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK: Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011, 260(3):892–899.CrossRef Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, Jung HK, Choi JS, Kim BM, Kim EK: Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011, 260(3):892–899.CrossRef
22.
Zurück zum Zitat Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L: European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017, 6(5):225–237.CrossRef Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L: European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017, 6(5):225–237.CrossRef
23.
Zurück zum Zitat Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L: Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 2013, 168(5):649–655.CrossRef Russ G, Royer B, Bigorgne C, Rouxel A, Bienvenu-Perrard M, Leenhardt L: Prospective evaluation of thyroid imaging reporting and data system on 4550 nodules with and without elastography. Eur J Endocrinol 2013, 168(5):649–655.CrossRef
24.
Zurück zum Zitat Wei X, Li Y, Zhang S, Gao M: Meta-analysis of thyroid imaging reporting and data system in the ultrasonographic diagnosis of 10,437 thyroid nodules. Head Neck 2016, 38(2):309–315.CrossRef Wei X, Li Y, Zhang S, Gao M: Meta-analysis of thyroid imaging reporting and data system in the ultrasonographic diagnosis of 10,437 thyroid nodules. Head Neck 2016, 38(2):309–315.CrossRef
25.
Zurück zum Zitat Ting S, Synoracki S, Bockisch A, Fuhrer D, Schmid KW: [Clinical importance of thyroid gland cytology]. Pathologe 2015, 36(6):543–552.CrossRef Ting S, Synoracki S, Bockisch A, Fuhrer D, Schmid KW: [Clinical importance of thyroid gland cytology]. Pathologe 2015, 36(6):543–552.CrossRef
26.
Zurück zum Zitat Cibas ES, Ali SZ, Conference NCITFSotS: The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 2009, 132(5):658–665.CrossRef Cibas ES, Ali SZ, Conference NCITFSotS: The Bethesda System For Reporting Thyroid Cytopathology. Am J Clin Pathol 2009, 132(5):658–665.CrossRef
27.
Zurück zum Zitat Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE, German Society for G, Visceral S: Indications for the Surgical Management of Benign Goiter in Adults. Dtsch Arztebl Int 2018, 115(1-02):1–7.PubMed Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE, German Society for G, Visceral S: Indications for the Surgical Management of Benign Goiter in Adults. Dtsch Arztebl Int 2018, 115(1-02):1–7.PubMed
28.
Zurück zum Zitat Nikiforov YE: Role of Molecular Markers in Thyroid Nodule Management: Then and Now. Endocr Pract 2017, 23(8):979–988.CrossRef Nikiforov YE: Role of Molecular Markers in Thyroid Nodule Management: Then and Now. Endocr Pract 2017, 23(8):979–988.CrossRef
29.
Zurück zum Zitat Dietlein M, Eschner W, Lassmann M, Verburg VA, Luster M: DGN Handlungsempfehlungen Schilddrüsenszinitigraphie Version 4 10/2014. Dietlein M, Eschner W, Lassmann M, Verburg VA, Luster M: DGN Handlungsempfehlungen Schilddrüsenszinitigraphie Version 4 10/2014.
30.
Zurück zum Zitat Gorges R, Kandror T, Kuschnerus S, Zimny M, Pink R, Palmedo H, Hach A, Rau H, Tanner C, Zaplatnikov K et al: [Scintigraphically „hot“ thyroid nodules mainly go hand in hand with a normal TSH]. Nuklearmedizin 2011, 50(5):179–188.CrossRef Gorges R, Kandror T, Kuschnerus S, Zimny M, Pink R, Palmedo H, Hach A, Rau H, Tanner C, Zaplatnikov K et al: [Scintigraphically „hot“ thyroid nodules mainly go hand in hand with a normal TSH]. Nuklearmedizin 2011, 50(5):179–188.CrossRef
31.
Zurück zum Zitat Graf D, Helmich-Kapp B, Graf S, Veit F, Lehmann N, Mann K: [Functional activity of autonomous adenoma in Germany]. Dtsch Med Wochenschr 2012, 137(41):2089–2092.CrossRef Graf D, Helmich-Kapp B, Graf S, Veit F, Lehmann N, Mann K: [Functional activity of autonomous adenoma in Germany]. Dtsch Med Wochenschr 2012, 137(41):2089–2092.CrossRef
32.
Zurück zum Zitat Feldkamp J, Fuhrer D, Luster M, Musholt TJ, Spitzweg C, Schott M: Fine Needle Aspiration in the Investigation of Thyroid Nodules. Dtsch Arztebl Int 2016, 113(20):353–359.PubMedPubMedCentral Feldkamp J, Fuhrer D, Luster M, Musholt TJ, Spitzweg C, Schott M: Fine Needle Aspiration in the Investigation of Thyroid Nodules. Dtsch Arztebl Int 2016, 113(20):353–359.PubMedPubMedCentral
33.
Zurück zum Zitat Dietlein M, Grunwald F, Schmidt M, Schneider P, Verburg FA, Luster M: [Radioiodine therapy for benign thyroid diseases (version 5). German Guideline]. Nuklearmedizin 2016, 55(6):213–220.CrossRef Dietlein M, Grunwald F, Schmidt M, Schneider P, Verburg FA, Luster M: [Radioiodine therapy for benign thyroid diseases (version 5). German Guideline]. Nuklearmedizin 2016, 55(6):213–220.CrossRef
34.
Zurück zum Zitat Grussendorf M, Reiners C, Paschke R, Wegscheider K, Investigators L: Reduction of thyroid nodule volume by levothyroxine and iodine alone and in combination: a randomized, placebo-controlled trial. J Clin Endocrinol Metab 2011, 96(9):2786–2795.CrossRef Grussendorf M, Reiners C, Paschke R, Wegscheider K, Investigators L: Reduction of thyroid nodule volume by levothyroxine and iodine alone and in combination: a randomized, placebo-controlled trial. J Clin Endocrinol Metab 2011, 96(9):2786–2795.CrossRef
Metadaten
Titel
Ein Zuviel und ein Zuwenig vermeiden
Zufallsbefund Schilddrüsenknoten: Wie geht es nun weiter?
verfasst von
PD. Dr. med. Roland Ladurner
Prof. Dr. med. Klaus Hallfeldt
Prof. Dr. med. Martin Angele
Prof. Dr. med. Jens Werner
Prof. Dr. med. Martin Reincke
Prof. Dr. med. Christine Spitzweg
Dr. med. Christian Lottspeich
Publikationsdatum
15.04.2019
Verlag
Springer Medizin
Erschienen in
MMW - Fortschritte der Medizin / Ausgabe 7/2019
Print ISSN: 1438-3276
Elektronische ISSN: 1613-3560
DOI
https://doi.org/10.1007/s15006-019-0406-y

Weitere Artikel der Ausgabe 7/2019

MMW - Fortschritte der Medizin 7/2019 Zur Ausgabe

Leitlinien kompakt für die Allgemeinmedizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Facharzt-Training Allgemeinmedizin

Die ideale Vorbereitung zur anstehenden Prüfung mit den ersten 24 von 100 klinischen Fallbeispielen verschiedener Themenfelder

Mehr erfahren

Neu im Fachgebiet Allgemeinmedizin

Update Allgemeinmedizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.