Wie werden Schilddrüsenknoten therapiert?

Zusammenfassung

Schilddrüsenknoten sind ein häufiger Befund in Deutschland. Etwa jeder Vierte ist davon betroffen. Bei den meisten Schilddrüsenknoten handelt es sich um benigne Befunde. Insbesondere echoarme Knoten mit Mikroverkalkungen, unregelmäßigem Randsaum oder verstärkter Durchblutung sind Malignom-verdächtig. Die meisten, vor allem kleine Knoten, sind nicht zwingend therapiebedürftig. Eine Jodid-Supplementation (nach Ausschluss einer Autonomie) sollte jedoch erfolgen. Eine Kombinationstherapie bestehend aus Schilddrüsenhormon und Jodid insbesondere zur Behandlung größerer Knoten hat noch bessere Behandlungserfolge. Bei latenter Hyperthyreose aufgrund einer Autonomie besteht eine relative Indikation zur Therapie. Eine manifeste Hyperthyreose muss therapiert werden, wobei die medikamentö-se Therapie im Vordergrund steht. Bei singulären autonomen Adenomen wird häufig eine Radiojodtherapie durchgeführt. Eine Struma multinodosa mit uni / multifokaler Autonomie wird bevorzugt operiert.

Abstract

Thyroid nodules are frequent in Germany. In about every fourth person thyroid nodules can be detected. Most of them are benign. Signs for malignancy are hypoechogenicity, microcalcifications, an unregular margin and increased blood perfusion. There is no strict indication for the treatment of benign nodules. In most cases iodine supplementation is sufficient. A combination therapy with levothyroxine and iodine is more efficient for the treatment of larger nodules. Subclinical hyperthyroidism caused by an adenoma does not necessarily need to be treated, whereas manifest hyperthyroidism needs to treated in most cases with antithyroid drug therapy. Radioiodine therapy is the classical indication for the treatment of unifocal autonomous adenomas. A largely increased thyroid gland with and without uni- / multifocal adenomas are often operated.

Schlüsselwörter

Struma nodosa - Therapie - autonomes Adenom - Hyperthyrose

Keywords

goiter - therapy - benign adenoma - thyrotoxicosis

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