Algorithmen für die Nachsorge des Schilddrüsenkarzinoms

Zusammenfassung

Die Neufassung bzw. Überarbeitung bestehender Leitlinien zur Nachsorge des Schilddrüsenkarzinoms ist aufgrund zahlreicher Publikationen in jüngerer Vergangenheit und neu gewonnener Erkenntnisse unverzichtbar und trägt zu einer erwünschten Standardisierung des Patientenmanagements bei. Neuerungen auf diagnostischem Gebiet betreffen in erster Linie die Etablierung der Hybridbildgebung (z. B. ¹³¹I-SPECT/CT), eine kontinuierliche Verbesserung der sonografischen Techniken und die Weiterentwicklung der Thyreoglobulin-Assays. Zunehmend gewinnt eine risikoorientiertes, individualisiertes Follow-up, z. B. mit einer „liberalisierten“ Einstellung des TSH, d. h. dem Verzicht auf eine lebenslange Suppression, an Bedeutung. Nachsorgeintervalle und insbesondere die Frequenz der Untersuchungen werden neu definiert und an das veränderte Patientenspektrum angepasst.

Fragen der Lebensqualität und psychosoziale Aspekte rücken mehr und mehr ins Blickfeld und sind Teil einer umfassenden Patientenbetreuung.

Abstract

As a result of many studies that have been published in the past few years and the new insights resulting from these publications, the update or renewal of existing guidelines regarding the follow-up of differentiated thyroid carcinoma is absolutely necessary and will contribute to the desired standardization of patient management. With regard to diagnostic procedures the changes primarily concern the introduction of hybrid imaging (e. g. I-131 SPECT/CT), continually improving ultrasound technology and further development of thyroglobulin assays. Furthermore a risk-adapted follow-up strategy including a more “liberal” policy with regard to TSH regulation, in which the strategy of life-long TSH suppression is abandoned, is now advocated much more strongly. Follow-up intervals and the frequency of diagnostic procedures have been adapted to the changing patient spectrum and have been defined anew. Questions concerning quality of life and psychosocial aspects are now focus of attention and are a part of comprehensive patient care.

Schlüsselwörter

Schilddrüsenkarzinom - Nachsorge - Hybridbildgebung - Schilddrüsenhormonsubstitution

Key words

Thyroid carcinoma - follow-up - hybrid imaging - thyroid hormone therapy

• Literatur

• 1 Biermann M, Pixberg M, Riemann B et al. Clinical outcomes of adjuvant external-beam radiotherapy for differentiated thyroid cancer – results after 874 patient-years of follow-up in the MSDS-trial. Nuklearmedizin 2009; 48: 89-98
• 2 Blum M, Tiu S, Chu M et al. I-131 SPECT/CT elucidates cryptic findings on planar whole-body scans and can reduce needless therapy with I-131 in post-thyroidectomy thyroid cancer patients. Thyroid 2011; 21: 1235-1247
• 3 Cooper DS, Doherty GM, Haugen BR et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-1214
• 4 Diessl S, Holzberger B, Mader U et al. Impact of Moderate vs. Stringent TSH Suppression on Survival in Advanced Differentiated Thyroid Carcinoma. Clin Endocrinol (Oxf) 2011;
• 5 Dietlein M, Dressler J, Eschner W et al. Procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer (version 3). Nuklearmedizin 2007; 46: 206-212
• 6 Dueren C, Dietlein M, Luster M et al. The Use of Thyrogen(R) in the Treatment of Differentiated Thyroid Carcinoma: An Intraindividual Comparison of Clinical Effects and Implications of Daily Life. Exp Clin Endocrinol Diabetes 2009;
• 7 Eustatia-Rutten CF, Smit JW, Romijn JA et al. Diagnostic value of serum thyroglobulin measurements in the follow-up of differentiated thyroid carcinoma, a structured meta-analysis. Clin Endocrinol (Oxf) 2004; 61: 61-74
• 8 Feldt-Rasmussen U, Profilis C, Colinet E et al. Human thyroglobulin reference material (CRM 457). 1^st Part: Assessment of homogeneity, stability and immunoreactivity. Ann Biol Clin (Paris) 1996; 54: 337-342
• 9 Fish SA, Langer JE, Mandel SJ. Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am 2008; 37: 401-417 ix
• 10 Hovens GC, Stokkel MP, Kievit J et al. Associations of serum thyrotropin concentrations with recurrence and death in differentiated thyroid cancer. J Clin Endocrinol Metab 2007; 92: 2610-2615
• 11 Kamaya A, Gross M, Akatsu H et al. Recurrence in the thyroidectomy bed: sonographic findings. AJR Am J Roentgenol 2011; 196: 66-70
• 12 Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract 2011; 17 (Suppl. 01) 18-25
• 13 Kloos RT, Mazzaferri EL. A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab 2005; 90: 5047-5057
• 14 Kohlfuerst S, Igerc I, Lobnig M et al. Posttherapeutic (131)I SPECT-CT offers high diagnostic accuracy when the findings on conventional planar imaging are inconclusive and allows a tailored patient treatment regimen. Eur J Nucl Med Mol Imaging 2009; 36: 886-893
• 15 Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97: 418-428
• 16 Mustafa M, Kuwert T, Weber K et al. Regional lymph node involvement in T1 papillary thyroid carcinoma: a bicentric prospective SPECT/CT study. Eur J Nucl Med Mol Imaging 2010; 37: 1462-1466
• 17 Pacini F, Schlumberger M, Dralle H et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787-803
• 18 Pacini F, Schlumberger M, Harmer C et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol 2005; 153: 651-659
• 19 Reiners C, Hanscheid H, Luster M et al. Radioiodine for remnant ablation and therapy of metastatic disease. Nat Rev Endocrinol. 2011
• 20 Rondeau G, Fish S, Hann LE et al. Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression. Thyroid 2011; 21: 845-853
• 21 Schlumberger M, Hitzel A, Toubert ME et al. Comparison of seven serum thyroglobulin assays in the follow-up of papillary and follicular thyroid cancer patients. J Clin Endocrinol Metab 2007; 92: 2487-2495
• 22 Schlumberger M, Mancusi F, Baudin E et al. 131I therapy for elevated thyroglobulin levels. Thyroid 1997; 7: 273-276
• 23 Schmidt D, Szikszai A, Linke R et al. Impact of 131I SPECT/Spiral CT on nodal staging of differentiated thyroid carcinoma at first radioablation. J Nucl Med 2009; 50: 18-23
• 24 Sobin LH, Wittekind C. editors TNM classification of malignant tumours. 6th ed. New York: Wiley-Liss; 2002
• 25 Spanu A, Solinas ME, Chessa F et al. 131I SPECT/CT in the follow-up of differentiated thyroid carcinoma: incremental value versus planar imaging. J Nucl Med 2009; 50: 184-190
• 26 Spencer CA, Bergoglio LM, Kazarosyan M et al. Clinical impact of thyroglobulin (Tg) and Tg autoantibody method differences on the management of patients with differentiated thyroid carcinomas. J Clin Endocrinol Metab 2005; 90: 5566-5575
• 27 Verburg FA, Stokkel MP, Duren C et al. No survival difference after successful (131)I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2010; 37: 276-283
• 28 Lorenz K, Weber T. Die chirurgische Perspektive: Bedeutung der FDGPET/CT-Diagnostik in der Rezidivchirurgie der differenzierten Schilddrüsenkarzinome. Der Nuklearmediziner 2010; 33: 233-241
• 29 Wong KK, Zarzhevsky N, Cahill JM et al. Incremental value of diagnostic 131I SPECT/CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR Am J Roentgenol 2008; 191: 1785-1794