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DOI: 10.3413/nukmed-0136
Survey of management of solitary thyroid nodules in Germany
Umfrage zum Management solitärer Schilddrüsenknoten in DeutschlandPublikationsverlauf
Received:
17. Juni 2007
accepted in revised form:
28. September 2007
Publikationsdatum:
04. Januar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/200803/lookinside/thumbnails/10-3413-nukmed-0136_de-1.jpg)
Summary
Aim: To compare the opinions of practitioners in primary care with those of thyroid specialists in Germany on the management of solitary thyroid nodules (Papillon 2005). Methods: Questionnaires were filled in by 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The test cases and their modifications described a solitary thyroid nodule of 2–3 cm with different levels of thyroid function and a hypoechogenic nodule of 1 cm in diameter. Results: TSH determination and sonography were found to be standard procedures, followed by scintigraphy (selected by 84.7% of practitioners and 95.1% of specialists, p < 0.001) and fine needle aspiration cytology (54.5% of practitioners, 57.4% of specialists). For a hypoechogenic nodule calcitonin determination was advocated by 54.0% of endocrinologists and by 32.2% of nuclear medicine physicians (p < 0.001). A euthyroid solitary thyroid nodule would be treated medically by 77.8% of practitioners and by 85.7% of specialists, the combination of levothyroxine and iodine being clearly preferred (60.9% of practitioners and 67.1% of specialists). For a hyperfunctioning nodule the preference of radioiodine therapy was significantly higher in the specialist group (88.8%) than among the practitioners (52.2%). Conclusions: The main differences of opinion between practitioners and specialists focused on calcitonin screening and referral to radioiodine therapy.
Zusammenfassung
Ziel: Vergleich zwischen den Ansichten von Hausärzten und Schilddrüsenexperten in Deutschland bei der Behandlung solitärer Schilddrüsenknoten (Papillon 2005). Methodik: Zwischen 1. Juni und 30. September 2005 wurden von 2191 Hausärzten und von 297 Spezialisten Fragebögen beantwortet. Die Indexpatientin hatte einen 2–3 cm großen Solitärknoten, modifiziert wurde die Schilddrüsenfunktion. Ein weiterer Indexpatient hatte einen 1 cm großen, echoarmen Knoten. Ergebnisse: TSH-Messung und Sonographie waren Standardprozeduren, gefolgt von Szintigraphie (angekreuzt von 84,7% der Hausärzte und 95,1% der Spezialisten, p < 0,001) und Feinnadelpunktion (54,5% der Hausärzte und 57,4% der Spezialisten). Bei einem echoarmen Knoten befürworteten 54,0% der Endokrinologen und 32,2% der Nuklearmediziner die Calcitonin- Messung (p < 0,001). Ein euthyreoter, solitärer Schilddrüsenknoten würde von 77,8% der Hausärzte und von 85,7% der Spezialisten medikamentös behandelt werden, bevorzugt mit einer Kombination aus Levothyroxin und Iodid (60,9% der Hausärzte und 67,1% der Spezialisten). Läge ein hyperfunktioneller Knoten vor, wurde die Radioiodtherapie von Spezialisten (88,8%) signifikant häufiger als von Hausärzten (52,2%) empfohlen. Schlussfolgerung: Unterschiedliche Befragungsergebnisse zwischen Hausärzten und Spezialisten betrafen die Themen Calcitonin- Screening und Indikation zur Radioiodtherapie.
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References
- 1 Andermann P, Schlögl S, Mäder U. et al. Intra- and interobserver variability of thyroid volume measurements in healthy adults by 2D versus 3D ultrasound. Nuklearmedizin 2007; 46: 1-7.
- 2 Baldini M, Gallazzi M, Orsatti A. et al. Treatment of benign nodular goiter with mildly suppressive doses of L-thyroxine: effects on bone mineral density and on nodule size. J Intern Med 2002; 251: 407-414.
- 3 Becker D, Bair HJ, Becker W. et al. Thyroid autonomy with color-coded image-directed Doppler so- nography: internal hypervascularization for the recognition of autonomous adenomas. J Clin Ultrasound 1997; 25: 63-69.
- 4 Bennedbaek FN, Perrild H, Hegedüs L. Diagnosis and treatment of solitary thyroid nodule. Results of a European survey. Clin Endocrinol (Oxf) 1999; 50: 357-363.
- 5 Bennedbaek FN, Hegedüs L. Management of the solitary thyroid nodule. Results of a North American survey. J Clin Endocrinol Metab 2000; 85: 2493-2498.
- 6 Berghout A, Wiersinga WM, Smits NJ. et al. Interrelationships between age, thyroid volume, thyroid nodularity, and thyroid function in patients with sporadic non-toxic goiter. Am J Med 1990; 89: 602-608.
- 7 Bonnema SJ, Bennedbsk FN, Wiersinga WM. et al. Management of the nontoxic multinodular goiter: a European questionnaire study. Clin Endocrinol (Oxf) 2000; 53: 5-12.
- 8 Bonnema SJ, Bennedbsk FN, Ladenson PW. et al. Management of the nontoxic multinodular goiter: a North American survey. J Clin Endocrinol Metab 2002; 87: 112-117.
- 9 Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab 2002; 87: 4154-4159.
- 10 Cooper DS, Doherty GM, Haugen BR. et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 1-33.
- 11 Diehl LA, Garcia V, Bonnema SJ. et al. Management of the nontoxic multinodular goiter in Latin America: comparison with North America and Europe, an electronic survey. J Clin Endocrinol Metab 2005; 90: 117-123.
- 12 Dietlein M, Moka D, Schmidt M. et al. Prevention, screening and therapy of thyroid diseases and their cost-effectiveness. Nuklearmedizin 2003; 42: 181-189.
- 13 Dietlein M, Dressler J, Grünwald F. et al. Guideline for in vivo and in vitro procedures for thyroid diseases (version 2). Nuklearmedizin 2003; 42: 109-115.
- 14 Dietlein M, Dressler J, Grünwald F. et al. Guideline for radioiodine therapy for benign thyroid diseases (version 4). Nuklearmedizin 2007; 46: 220-223.
- 15 Dietlein M, Kobe C, Schmidt M. et al. The incidentaloma of the thyroid: over- or underuse of diagnostic procedures for an epidemiologic finding?. Nuklearmedizin 2005; 44: 213-224.
- 16 Dietlein M, Dederichs B, Kobe C. et al. Therapy for non-toxic multinodular goiter: radioiodine therapy as attractive alternative to surgery. Nuklearmedizin 2006; 45: 21-34.
- 17 Dietlein M, Wegscheider K, Vaupel R. et al. Management of multinodular goiter in Germany. Do the approaches of thyroid specialists and primary care practitioners differ? (Papillon 2005) Nuklearmedizin 2007; 41: 65-75.
- 18 Dietlein M, Moka D, Reinholz U. et al. Administration of additional inactive iodide during radio- iodine therapy for Graves' disease. Who might benefit? Nuklearmedizin 2007; 46: 77-84.
- 19 Dietlein M, Wieler H, Schmidt M. et al. Routine measurement of serum calcitonin in patients with nodular thyroid disorders?. Nuklearmedizin 2008; 47: 65-72.
- 20 Elisei R, Bottici V, Luchetti F. et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 2004; 89: 163-168.
- 21 From G, Mellemgaard A, Knudsen N. et al. Review of thyroid cancer cases among patients with previous benign thyroid disorders. Thyroid 2000; 10: 697-700.
- 22 Führer D, Mügge C, Paschke R. Questionnaire on management of nodular thyroid disease (Annual Meeting of the Thyroid Section of the German Society of Endocrinology 2003). Exp Clin Endocrinol Diabetes 2005; 113: 152-159.
- 23 Gharib H, James EM, Charboneau JW. et al. Sup- pressive therapy with levothyroxine for solitary thyroid nodules. A double-blind controlled clinical study. N Engl J Med 1987; 317: 70-75.
- 24 Gotthardt M, Stübinger M, Pansegrau J. et al. Decrease of 99mTc-uptake in autonomous thyroid tissue in Germany since the 1970s. Nuklearmedizin 2006; 45: 122-125.
- 25 Gotthardt M, Rubner C, Bauhofer A. et al. What is the best pre-therapeutic dosimetry for successful radioiodine therapy of multifocal autonomy?. Nuklearmedizin 2006; 45: 206-212.
- 26 Grussendorf M, Vaupel R, Reiners C. et al the LISA-study group. The LISA trial-a randomized, double-blind, placebo-controlled four-arm study of 1,000 patients with nodular goiter in Germany. Study design and first results of feasibility. Med Klinik 2005; 100: 542-546.
- 27 Hagag P, Strauss S, Weiss M. Role of ultrasound- guided fine-needle aspiration biopsy in evaluation ofnon-palpable thyroid nodules. Thyroid 1998; 8: 989-995.
- 28 Hampel R. Aktuelle Iodversorgung in Deutschland. In: Dietlein M, Schicha H. (Hrsg) Schilddrüse 2003-Zufallsbefund Schilddrüsenknoten-Latente Schilddrüsenfunktionsstörungen. Berlin: de Gruyter; 2004: 52-61.
- 29 Kahaly GJ, Dietlein M. Cost estimation of thyroid disorders in Germany. Thyroid 2002; 12: 909-914.
- 30 Karges W, Dralle H, Raue F. et al. Calcitonin measurement to detect medullary thyroid carcinoma in nodular goiter: German evidence-based consensus recommendation. Exp Clin Endocrinol Diabetes 2004; 112: 52-58.
- 31 La Rosa G, Lupo L, Giuffrida D. et al. Levothyr- oxine and potassium iodide are both effective in treating benign solitary solid cold nodules of the thyroid. Ann Intern Med 1995; 122: 1-8.
- 32 Larijani B, Pajouhi M, Bastanhagh M. et al. Evaluation of suppressive therapy for cold thyroid nodules with levothyroxine: double blind placebo- controlled clinical trial. Endocr Pract 1999; 5: 251-256.
- 33 Leenhardt L, Hejblum G, Franc B. et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab 1999; 84: 24-28.
- 34 Liel Y, Ariad S, Barchana M. Long-term follow-up of patients with initially benign thyroid fine- needle aspirations. Thyroid 2001; 11: 775-778.
- 35 Luster M, Führer D, Engelhardt C. et al. Prävalenz von szintigraphisch heißen, kalten und indifferenten Schilddrüsenknoten bei Patienten mit bekanntem solitärem Herdbefund. Nuklearmedizin 2005; 44: A6-A7.
- 36 Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993; 328: 553-559.
- 37 Mellemgaard A, From G, Jorgensen T. et al. Cancer risk in individuals with benign thyroid disorders. Thyroid 1998; 8: 751-754.
- 38 Nam-Goong IS, Kim HY, Gong G. et al. Ultra- sonography-guided fine-needle aspiration of thyroid incidentaloma: correlation with pathologic findings. Clin Endocrinol 2004; 60: 21-28.
- 39 Pacini F, Schlumberger M, Dralle H. et al. the European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787-803.
- 40 Papini E, Bacci V, Panunzi C. et al. A prospective randomized trial of levothyroxine suppressive therapy for solitary thyroid nodules. Clin Endocrinol (Oxf) 1993; 38: 507-513.
- 41 Papini E, Petruci L, Guglielmi R. et al. Long-term changes in nodular goiter: a 5-year prospective randomized trial of levothyroxine suppressive therapy for benign cold thyroid nodules. J Clin Endocrinol Metab 1998; 83: 780-783.
- 42 Papini E, Guglielmi R, Bianchini A. et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002; 87: 1941-1946.
- 43 Parle JV, Maisonneuve P, Sheppard MC. et al. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 2001; 358: 861-865.
- 44 Quadbeck B, Pruellage J, Roggenbuck U. Long- term follow-up of thyroid nodule growth. Exp Clin Endocrinol Diabetes 2002; 110: 348-354.
- 45 Raber W, Kmen E, Kaserer K. et al. The cold thyroid nodule: 20 year experience with 2071 patients and diagnostic limitations of fine needle aspiration biopsy. Wien Klin Wochenschr 1991; 109: 116-122.
- 46 Raber W, Kaserer K, Niederle B. et al. Risk factors for malignancy of thyroid nodules initially identified as follicular neoplasia by fine-needle aspiration: results of a prospective study of one hundred twenty patients. Thyroid 2000; 10: 709-712.
- 47 Ravetto C, Colombo L, Dottorini ME. Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma. A retrospective study in 37,895 patients. Cancer (Cancer Cytopathol) 2000; 90: 357-363.
- 48 Reiners C, Wegscheider K, Schicha H. et al. Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unchosen employees. Thyroid 2004; 14: 926-932.
- 49 Schumm-Draeger PM, Vaupel R, Wegscheider K. Insufficient adherence to recommendations on medical treatment of patients with nodular or diffuse goiter by German practitioners. Med Welt 2006; 57: 224-227.
- 50 Tagay S, Herpertz S, Langkafel M. et al. Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothy- roidism and TSH-suppressive levothyroxine treatment. Eur J Endocrinol 2005; 153: 755-763.
- 51 Verschreibungsindex für Pharmazeutika. IMS VIP®. 2005 www.imshealth.de.
- 52 Völzke H, Ludemann J, Robinson DM. et al. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13: 803-810.
- 53 Vogt H, Wengenmair H, Kopp J. et al. Radioiodine therapy for combined disseminated and nodular thyroid autonomy. Nuklearmedizin 2006; 45: 101-104.
- 54 Watt T, Groenvold M, Rasmussen AK. et al. Quality of life in patients with benign thyroid disorders. A review. Eur J Endocrinol 2006; 154: 501-510.
- 55 Wemeau J-L, Caron P, Schvartz C. et al. Effects of thyroid-stimulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular non-palpable changes: a randomized, double-blind, placebo-controlled trial by the French Thyroid Research Group. J Clin Endocrinol Metab 2002; 87: 4928-4934.
- 56 Wesche MF, Tiel-Van Buul MM, Lips P. et al. A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter. J Clin Endocrinol Metab 2001; 86: 998-1005.
- 57 Zelmanovitz F, Genro S, Gross J. Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analyses. J Clin Endocrinol Metab 1998; 83: 3881-3885.