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

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