Das Schilddrüsenkarzinom ist mit steigender Inzidenz der häufigste endokrine Tumor und tritt in 90 % in einer differenzierten Variante (papillär und follikulär) mit meist niedriger Mortalität auf [1]. Die Behandlung dieser differenzierten Schilddrüsenkarzinome hat sich in den letzten Jahren hin zu einem individuellen Behandlungsmanagement verändert. Auch die Nachsorgeprinzipien wurden durch aktuelle Studien, Leitlinien und Verfahrensanweisungen neu ausgerichtet.
Abstract
The management of differentiated thyroid carcinoma has shown considerable changes in recent years, moving away from a fixed therapy regimen towards individual treatment strategies. The aim of our work (literature research) is to present current developments in the follow-up of differentiated thyroid cancer.
For the management of individual follow-up, an initial evaluation and, at later time points, the re-evaluation of the risk of recurrence is crucial. The performance of I-131-diagnostics after radioiodine therapy can provide essential information and can be seen as a survey of a new baseline situation, in order to be able to draw a comparison in case of a rising Thyreoglobulin (Tg).
The measurement of Tg with a highly sensitive assays shows a high negative predictive value. Negative Tg measurements with these assays seem to indicate complete remission even with Tg antibodies being present. An increasing Tg value in follow-up implies further diagnostic work-up, primarily neck ultrasonography. Sonographically suspicious findings should be subjected to fine needle biopsy, whereby in addition to cytological processing, determination of Tg from the sample can be recommended. If the suspicious lesion cannot be displayed sonographically and Tg values keep rising, computed tomography (CT) and magnetic resonance imaging (MRI) of the neck region can provide further information. FDG-PET/CT has also shown an excellent performance in this setting.
The previously fixed therapy regimen has been realigned towards an individual treatment management. Current studies and guidelines lead to a repetitive recurrence risk evaluation and the adjustment of the aftercare planning to the individual risks with appropriately selected examination methods and personalized intervals of assessment.
Schlüsselwörter
differenziertes Schilddrüsenkarzinom - Nachsorge - Jod-131-Ganzkörperszintigrafie
Key words
differentiated thyroid cancer - follow-up - radioiodine whole-body scan
