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Differenzierte Schilddrüsenkarzinome

Differentiated thyroid cancer

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Zusammenfassung

Schilddrüsenkarzinome sind selten und klinisch sehr heterogen. Therapie und Nachsorge müssen auf das individuelle Risiko eines günstigen oder ungünstigen Verlaufs abgestimmt werden. Differenzierte Schilddrüsenkarzinome werden zu einem hohen Anteil durch eine Operation und ggf. Radiojodbehandlung geheilt. In Abhängigkeit vom initialen Therapieansprechen sollte das Rezidivrisiko im Verlauf neu eingeschätzt werden. Eine dauerhafte Suppression des thyreoideastimulierenden Hormons (TSH) mit Levothyroxin wird heute nur noch bei Patienten mit hohem Risiko für einen ungünstigen Verlauf empfohlen. Metastasierte radiojodrefraktäre Schilddrüsenkarzinome weisen eine ungünstige Prognose auf. Für diese Sondersituation stehen multimodale Behandlungskonzepte einschließlich der Gabe von Tyrosinkinaseinhibitoren zur Verfügung. Aufgrund der Komplexität der Erkrankung sollte die Behandlung von Schilddrüsenkarzinompatienten in Absprache mit einem erfahrenen interdisziplinären Team erfolgen.

Abstract

Thyroid carcinoma is a rare and heterogeneous disease. Initial therapy and follow-up has to be adjusted to the individual risk for an excellent vs. poor prognosis. Differentiated thyroid cancer has a very high cure rate and is treated by surgery, usually followed by radioiodine ablation. Depending on the response to initial therapy the risk for persisting or recurrent disease should be re-evaluated. Continued TSH suppressive levothyroxine therapy is only recommended in high-risk patients. In contrast, metastatic radioiodine-refractory thyroid cancers have a poor prognosis and may benefit from multidisciplinary treatment concepts including tyrosine kinase inhibitors. Due to its complexity, management of thyroid cancer patients should be performed in close collaboration with a specialized thyroid cancer team.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Führer: Beratungs- und Referententätigkeit: AstraZeneca, Bayer, Eisai, Genzyme, Sanofi-Aventis, Pfizer, Sobi. V. Tiedje: Beratungs- und Referententätigkeit: AstraZeneca, Sobi, Eisai. K.W. Schmid und F. Weber und A. Bockisch geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Endokrinologie und Stoffwechselerkrankungen, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    V. Tiedje & D. Führer

  2. Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland

    K.W. Schmid

  3. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland

    F. Weber

  4. Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Deutschland

    A. Bockisch

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  1. V. Tiedje
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  2. K.W. Schmid
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  3. F. Weber
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  4. A. Bockisch
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  5. D. Führer
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Correspondence to V. Tiedje.

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Tiedje, V., Schmid, K., Weber, F. et al. Differenzierte Schilddrüsenkarzinome. Internist 56, 153–168 (2015). https://doi.org/10.1007/s00108-014-3637-0

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  • DOI: https://doi.org/10.1007/s00108-014-3637-0

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