Management of multinodular goiter in Germany (Papillon 2005)

Summary

Aim: Large-scale survey to focus on management of multinodular goiter and to compare the approaches of practitioners in primary care and thyroid specialists in Germany. Methods: Replies to a questionnaire were received from 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The hypothetical cases and their modifications described multinodular goiters of different sizes with and without toxic nodules. Results: In the workup, TSH determination and thyroid sonography were found to be standard procedures. Scintigraphy was selected by 80.2% of practitioners and 92.9% of specialists (p <0.001), in preference to fine needle aspiration cytology (17.9% of practitioners and 34.5% of the specialists, p <0.001). Only 6.1% of practitioners and 24.4% of specialists (p <0.001) advocated calcitonin screening. Euthyroid multinodular goiter (50-80 ml) was treated medically by 67.1% of practitioners and 65.6% of specialists, the combination of levothyroxine with iodine being clearly preferred (54.5% of practitioners, 52.3% of specialists). For toxic nodular goiter the preference for radioiodine therapy was significantly higher (p <0.001) among specialists (67.7%) than among practitioners (47.5%). Referral to surgery was recommended for cold nodules with negative cytology by 64.9% of practitioners and 73.5% of specialists (p = 0.004). Conclusions: Treatment and diagnostic procedures are used to nearly the same extent in primary care and specialist institutions, but the opinions diverge over the issues of calcitonin screening and referral for radioiodine therapy.

Zusammenfassung

Ziel: Eine umfangreiche Umfrage beschäftigte sich mit der Behandlung der multinodulären Struma und verglich die Strategien der Hausärzte und der Schilddrüsenspezialisten in Deutschland. Methodik: Zwischen 1. Juni und 30. September 2005 wurden von 2191 Hausärzten und von 297 Schilddrüsenspezialisten Fragebögen beantwortet. Die Indexpatientin hatte eine Knotenstruma (50-80 ml), modifiziert wurden das Strumavolumen und der funktionelle Status der Knoten. Ergebnisse: Standardprozeduren waren die TSH-Messung und die Sonographie. Die Szintigraphie wurde von 80,2% der Hausärzte und von 92,9% der Experten angefordert (p <0,001) und erhielt den Vorzug vor einer Feinnadelpunktion (17,9% der Hausärzte und 34,5 % der Spezialisten, p <0,001). Nur 6,1% der Hausärzte und 24,4% der Spezialisten (p <0.001) befürworteten ein Calcitonin-Screening. Die euthyreote Knotenstruma (50-80 ml) wurde von 67,1% der Hausärzte und von 65,6% der Spezialisten medikamentös behandelt, dabei wurde eine Kombination aus Levothyroxin und Iodid bevorzugt (54,5% der Hausärzte, 52,3% der Spezialisten). Ging die Knotenstruma mit einer latenten Hyperthyreose einher, empfahlen die Spezialisten eine Radioiodtherapie signifikant häufiger (67,7%) als die Hausärzte (47,5%) (p <0,001). Patienten mit einem kalten Knoten und unauffälliger Zytologie wurden von 64,9 % der Hausärzte und von 73,5 % der Spezialisten zur Operation überwiesen (p = 0,004). Schlussfolgerung: Diagnostische und therapeutische Maßnahmen wurden in nahezu gleichem Ausmaß von Hausärzten und Spezialisten befürwortet. Unterschiede betrafen das Calcitonin-Screening und die Zuweisung zur Radioiodtherapie.

Keywords

Thyroid - goiter - levothyroxine - iodine - radioiodine therapy - questionnaire - primary care

Schlüsselwörter

Schilddrüse - Kropf - Levothyroxin - Iodid - Radioiodtherapie - Fragebogen - Primärversorgung

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