Questionnaire on Management of Nodular Thyroid Disease (Annual Meeting of the Thyroid Section of the German Society of Endocrinology 2003)

Abstract

Nodular thyroid disease is highly prevalent in iodine deficient areas. In Germany it affects approximately 30 % of the adult population. Differential diagnosis of thyroid nodules is directed at exclusion of rare thyroid malignancy and assessment of the nodules' functional characteristics in order to determine the best treatment approach.

In 2003 the annual meeting of the Sektion Schilddrüse, a thyroid specialist group of the German Society of Endocrinology addressed the topic of “management of benign nodular thyroid disease”. To assess the current diagnostic and therapeutic approach to nodular thyroid disease by German thyroid experts we designed a questionnaire, which was sent to all members of the Thyroid Section before the meeting and was answered by 70 % of the participants. We here report the results of the questionnaire, which show a considerable national heterogeneity in the management of thyroid nodules as well as diagnostic and treatment preferences for different thyroid specialist subgroups, e.g. endocrinologists and nuclear medicine specialist. This is in agreement with results of previous questionnaires assessing state-of-the-art practise among members of the European and American Thyroid Associations and underlines the definite need for a consensus process and for carefully planned randomized trials to answer the many unresolved questions in diagnosis and therapy of nodular thyroid disease.

Key words

Thyroid nodule - ultrasound - scintiscan - FNAC - medical treatment

References

• 1 Alexander E K, Hurwitz S, Heering J P, Benson C B, Frates M C, Doubilet P M, Cibas E S, Larsen P R, Marqusee E. Natural history of benign solid and cystic thyroid nodules.  Ann Intern Med. 2003;  138 315-318
• 2 Bennedbaek F N, Perrild H, Hegedus L. Diagnosis and treatment of the solitary thyroid nodule. Results of a European survey.  Clin Endocrinol. 2000 a;  50 357-363
• 3 Bennedbaek F N, Hegedus L. Management of the solitary thyroid nodules results of a North American Survey.  J Clin Endocrinol Metab. 2000 b;  85 2493-2498
• 4 Bonnema S J, Bennedbaek F N, Wiersinga W M. Management of the nontoxic multinodular goitre: a European questionnaire study.  Clin Endocrinol. 2000;  53 5-12
• 5 Bonnema S J, Bennedbaek F N, Ladenson P W, Hegedus L. Management of the nontoxic multinodular goiter: a North American survey.  J Clin Endocrinol Metab. 2002;  87 112-117
• 6 Brauer V F, Hentschel B, Paschke R. Euthyroid thyroid nodules. Aims, results and perspectives concerning drug therapy.  Dtsch Med Wochenschr. 2003;  128 2381-2387
• 7 Castro M R, Caraballo P J, Morris J C. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis.  J Clin Endocrinol Metab. 2002;  87 4154-4159
• 8 Dietlein M, Dressler J, Grunwald F, Joseph K, Leisner B, Moser E, Reiners C, Rendl J, Schicha H, Schneider P, Schober O. Deutsche Gesellschaft für Nuklearmedizin . Guideline for in vivo and in vitro procedures for thyroid diseases (version 2).  Nuklearmedizin. 2003;  42 109-115
• 9 Franklyn J A. Commentary: Lack of consensus in Europe in the management of nontoxic multinodular goitre.  Clin Endocrinol. 2000;  53 3-4
• 10 Hampel R, Kulberg T, Klein K, Jerichow J U, Pichmann E G, Clausen V, Schmidt I. Goiter incidence in Germany is greater than previously suspected.  ed Klin. 1995;  90 324-329
• 11 Hegedus L, Bonnema S J, Bennedbaek F N. Management of simple nodular goiter: current status and future perspectives.  Endocr Rev. 2003;  24 102-132
• 12 Kahaly G J, Dietlein M. Cost estimation of thyroid disorders in Germany.  Thyroid. 2002;  12 909-914
• 13 Karges W, Dralle H, Raue F, Mann K, Reiners C, Grussendorf M, Hufner M, Niederle B, Brabant G. Calcitonin measurement to detect medullary thyroid carcinoma in nodular goiter: German evidence-based consensus recommendation.  Exp Clin Endocrinol Diabetes. 2004;  112 52-58
• 14 Knudsen N, Laurberg P, Perrild H, Bulow I, Ovesen L, Jorgensen T. Risk factors for goiter and thyroid nodules.  Thyroid. 2002;  12 879-888
• 15 Krohn K, Fuhrer D, Bayer Y, Eszlinger M, Brauer V, Neumann S, Paschke R. Molecular pathogenesis of euthyroid and toxic multinodular goiter.  . 2004;  submitted
• 16 Mazzaferri E L. Thyroid cancer in thyroid nodules: finding a needle in the haystack.  Am J Med. 1992;  93 359-362
• 17 Mazzaferri E L. Management of a solitary thyroid nodule.  N Engl J Med. 1993;  328 553-559
• 18 Ortiz R, Hupart K H, DeFesi C R, Surks M I. Effect of early referral to an endocrinologist on efficiency and cost of evaluation and development of treatment plan in patients with thyroid nodules.  J Clin Endocrinol Metab. 1998;  83 3803-3807
• 19 Papini E. The dilemma of non-palpable thyroid nodules.  J Endocrinol Invest. 2003;  26 3-4
• 20 Rojeski M T, Gharib H. Nodular thyroid diesase. evaluation and management.  N Engl J Med. 1985;  313 428-436
• 21 Saller B, Esser H, Horn K. et al . Diagnostik und Therapie von Schilddrüsenkrankheiten. Empfehlungen zur Qualitätssicherung.  Der Internist. 1997;  38 177-185
• 22 Singer A, Cooper D S, Daniels G H, Ladenson P W, Greenspan F S, Levy E G, Braverman L E, Clark O H, McDougall I R, Ain K V, Dorfman S G. Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer.  Arch Intern Med. 1996;  156 2165-2172
• 23 Surks M I, Ortiz E, Daniels G H, Sawin C T, Col N F, Cobin R H, Franklyn J A, Hershman J M, Burman K D, Denke M A, Gorman Cooper R S, Weissman N J. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.  JAMA. 2004;  291 228-238
• 24 Tan G H, Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging.  Ann Intern Med. 1997;  126 226-231
• 25 Topliss D. Thyroid incidentaloma: the ignorant in pursuit of the inpalpable.  Clin Endocrinol (Oxf). 2004;  60 18-20
• 26 Volzke H, Ludemann J, Robinson D M, Spieker K W, Schwahn C, Kramer A, John U, Meng W. The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area.  Thyroid. 2003;  13 803-810