Download PDF
Dtsch Med Wochenschr 2020; 145(17): 1236-1244
DOI: 10.1055/a-1007-4121
Dossier

Nachsorge beim differenzierten Schilddrüsenkarzinom

Follow-up of differentiated thyroid cancer
Friederike Eilsberger
,
Andreas Pfestroff
,
Damiano Librizzi
,
Markus Luster
› Further Information
Also available at
    Permissions and Reprints

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


Publication History

Article published online:
07 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Bikas A, Burman KD. Epidemiology of Thyroid Cancer. In: Luster M. et al. The Thyroid and Its Diseases. Heidelberg: Springer; 2019: 541-547
    CrossrefGoogle Scholar
  • 2 Haugen BR, Tuttle RM, Wartofsky L. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26 (01) 1-133
    CrossrefPubMedGoogle Scholar
  • 3 Verburg FA, Schmidt M, Kreissl MC. et al. Jod-131-Ganzkörperszintigrafie beim differenzierten Schilddrüsenkarzinom. Stand 1/2019, AWMF-Registrierungsnummer: 031-013.
    PubMedGoogle Scholar
  • 4 Van Nostrand D. Selected Controversies of Radioiodine Imaging and Therapy in Differentiated Thyroid Cancer. Endocrinol Metab Clin N Am 2017; 46: 783-793
    CrossrefPubMedGoogle Scholar
  • 5 Verburg FA, Mäder U, Giovanella L. et al. Low or Undetectable Basal Thyreoglobulin Levels Obviate the Need for Neck Ultrasound in Differentiated Thyroid Cancer Patients After Total Thyreoidectomie and I-131 Ablation. Thyroid 2018; 28 (06) 722-728
    CrossrefPubMedGoogle Scholar
  • 6 Leenhardt L, Erdogan MF, Hegedus L. et al. 2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer. Eur Thyroid J 2013; 2: 147-159
    CrossrefPubMedGoogle Scholar
  • 7 Jeon MJ, Kim M, Park S. et al. A Follow-Up Strategy for Patients with an Excellent Response to Initial Therapy for Differentiated Thyroid Carcinoma: Less Is Better. Thyroid 2018; 28 (02) 187-192
    CrossrefPubMedGoogle Scholar
  • 8 Giovanella L, Treglia G, Sadeghi R. et al. Unstimulated highly sensitive thyroglobulin in follow-up of differentiated thyroid cancer patients: a meta-analysis. J Clin Endocrinol Metab 2014; 99 (02) 440-447
    CrossrefPubMedGoogle Scholar
  • 9 Chindris AM, Diehl NN, Crook JE. et al. Undetectabe sensitive serum thyroglobulin (<0.1 ng/ml) in 163 patients with follicular cell-derived thyroid cancer: results of rhTHS stimulation and neck ultrasonography and long-term biochemical and clinical follow-up. J Clin Endocrinol Metab 2012; 97 (08) 2714-2723
    CrossrefPubMedGoogle Scholar
  • 10 Spencer C, Fatemi S, Singer P. et al. Serum Basal thyroglobulin measured by a second-generation assay correlates with the recombinant human thyrotropin-stimulated thyroglobulin response in patients treated for differentiated thyroid cancer. Thyroid 2019; 20 (06) 587-595
    CrossrefPubMedGoogle Scholar
  • 11 Giovanella L. Circulating biomarkers for the detection of tumor recurrence in the postsurgical follow-up of differentiated thyroid carcinoma. Curr Opin Oncol 2020; 32 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 12 Leboulleux S, Girard E, Rose M. et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab 2007; 92 (09) 3590-3594
    CrossrefPubMedGoogle Scholar
  • 13 Scharpf J, Tuttle M, Wong R. et al. Comprehensive management of recurrent thyroid cancer: An American Head and Neck Society consensus statement: AHNS consensus statement. Head Neck 2016; 38 (12) 1862-1869
    CrossrefPubMedGoogle Scholar
  • 14 Frasoldati A, Pesenti M, Gallo M. et al. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer 2003; 97 (01) 90-96
    CrossrefPubMedGoogle Scholar
  • 15 Torres MR, Nobrega Neto SH, Rosos RJ. et al. Thyreoglobulin in the washout fluid of lymph-node biopsy: what is the role in the follow-up of differentiated thyroid carcinoma?. Thyroid 2014; 24 (01) 7-18
    CrossrefPubMedGoogle Scholar
  • 16 Robenshtok E, Fish S, Bach A. et al. Suspicious Cervical Lymph Nodes Detected after Thyroidectomy for Papillary Thyroid Cancer Usually Remain Stable Over Years in Properly Selected Patients. J Clin Endocrinol Metab 2012; 97 (08) 2706-2713
    CrossrefPubMedGoogle Scholar
  • 17 Schuff KG, Weber SM, Givi B. et al. Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope 2008; 118 (05) 768-775
    CrossrefPubMedGoogle Scholar
  • 18 Al-Saif O, Farrar WB, Bloomston M. et al. Long-Term Efficacy of Lymph Node Reoperation for Persistent Papillary Thyroid Cancer. J Clin Endocrinol Metabol 2010; 95 (05) 2187-2194
    CrossrefPubMedGoogle Scholar
  • 19 Larg MI, Barbus E, Gabora K. et al. 18F-FDG PET/CT in Differentiated Thyroid Carcinoma. Acta Endocrinol (Burchar) 2019; 15 (02) 203-208
    CrossrefPubMedGoogle Scholar