Survey of management of solitary thyroid nodules in Germany

Summary

Aim: To compare the opinions of practitioners in primary care with those of thyroid specialists in Germany on the management of solitary thyroid nodules (Papillon 2005). Methods: Questionnaires were filled in by 2,191 practitioners and 297 thyroid specialists between June 1 and September 30, 2005. The test cases and their modifications described a solitary thyroid nodule of 2–3 cm with different levels of thyroid function and a hypoechogenic nodule of 1 cm in diameter. Results: TSH determination and sonography were found to be standard procedures, followed by scintigraphy (selected by 84.7% of practitioners and 95.1% of specialists, p < 0.001) and fine needle aspiration cytology (54.5% of practitioners, 57.4% of specialists). For a hypoechogenic nodule calcitonin determination was advocated by 54.0% of endocrinologists and by 32.2% of nuclear medicine physicians (p < 0.001). A euthyroid solitary thyroid nodule would be treated medically by 77.8% of practitioners and by 85.7% of specialists, the combination of levothyroxine and iodine being clearly preferred (60.9% of practitioners and 67.1% of specialists). For a hyperfunctioning nodule the preference of radioiodine therapy was significantly higher in the specialist group (88.8%) than among the practitioners (52.2%). Conclusions: The main differences of opinion between practitioners and specialists focused on calcitonin screening and referral to radioiodine therapy.

Zusammenfassung

Ziel: Vergleich zwischen den Ansichten von Hausärzten und Schilddrüsenexperten in Deutschland bei der Behandlung solitärer Schilddrüsenknoten (Papillon 2005). Methodik: Zwischen 1. Juni und 30. September 2005 wurden von 2191 Hausärzten und von 297 Spezialisten Fragebögen beantwortet. Die Indexpatientin hatte einen 2–3 cm großen Solitärknoten, modifiziert wurde die Schilddrüsenfunktion. Ein weiterer Indexpatient hatte einen 1 cm großen, echoarmen Knoten. Ergebnisse: TSH-Messung und Sonographie waren Standardprozeduren, gefolgt von Szintigraphie (angekreuzt von 84,7% der Hausärzte und 95,1% der Spezialisten, p < 0,001) und Feinnadelpunktion (54,5% der Hausärzte und 57,4% der Spezialisten). Bei einem echoarmen Knoten befürworteten 54,0% der Endokrinologen und 32,2% der Nuklearmediziner die Calcitonin- Messung (p < 0,001). Ein euthyreoter, solitärer Schilddrüsenknoten würde von 77,8% der Hausärzte und von 85,7% der Spezialisten medikamentös behandelt werden, bevorzugt mit einer Kombination aus Levothyroxin und Iodid (60,9% der Hausärzte und 67,1% der Spezialisten). Läge ein hyperfunktioneller Knoten vor, wurde die Radioiodtherapie von Spezialisten (88,8%) signifikant häufiger als von Hausärzten (52,2%) empfohlen. Schlussfolgerung: Unterschiedliche Befragungsergebnisse zwischen Hausärzten und Spezialisten betrafen die Themen Calcitonin- Screening und Indikation zur Radioiodtherapie.

Keywords

Questionnaire - primary care - thyroid nodule - calcitonin - levo thyroxine - iodine - radioiodine therapy

Schlüsselwörter

Fragebogen - Primärversorgung - Schilddrüsenknoten - Calcitonin - Levothyroxin - Iodid - Radioiodtherapie

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