Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association’s guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. Mehr

German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease

Benign thyroid disorders are among the most common diseases in Germany, affecting around 15 million
people and leading to more than 100,000 thyroid surgeries per year. Since the first German guidelines for the surgical treatment of benign goiter were published in 1998, abundant new information has become available, significantly shifting surgical strategy towards more radical interventions. Additionally, minimally invasive techniques have been developed and gained wide usage. These circumstances demanded a revision of the guidelines. Mehr

Ektopische Schilddrüse

A  12-year-old girl presented with a lump situated high in her neck
at the midline (Panel A). She had previously been found to have hypothyroidism
and had been treated with levothyroxine. There were no signs of infection.
An ultrasonogram showed a solid midline mass. Mehr

Delayed Graves' Ophthalmopathology

An 18-year-old man who was being treated for Graves' disease presented to the clinic after several months of progressive eye changes. He had received a diagnosis of Graves' disease at 13 years of age and was treated with radioiodine. He had also been receiving thyroid hormone–replacement therapy for the past 4 years because of the subsequent development of hypothyroidism. Findings on physical examination revealed exotropia of the right eye, bilateral proptosis, periorbital edema, and conjunctival irritation (Panel A). Conservative management of his condition with oral prednisone provided no improvement. Subsequent bilateral orbital decompression surgery also failed to halt the progression of symptoms, including increasing loss of vision and extraocular motility disturbance. Computed tomography of the head showed worsening proptosis and enlarged eye muscles (Panel B, arrows). In children and adolescents, Graves' ophthalmopathy typically appears during the acute hyperthyroid phase and is usually mild and self-limited. In rare cases, severe Graves' ophthalmopathy persists or, as in this patient, is reactivated several years after its first occurrence, despite treatment and resolution of Graves' disease. In this patient, since symptoms progressed after conservative and surgical treatment, orbital radiation was administered and resulted in gradual clinical improvement.

NEJM Volume 362:e60 May 6,2010 Number 18

Nachlese - 7. Tagung der Rhein-Main-AG Minimal Invasive Chirurgie

Donnerstag 4.3.2010
Freitag 5.3.2010

Immer mehr Menschen leiden an einer Unterfunktion der Schilddrüse...

Concern over inappropriate diagnosis and treatment of thyroid problems(Editorial: Diagnosis and treatment of primary hypothyroidism) http://www.bmj.com/cgi/doi/10.1136/bmj.b725

More and more people are being inappropriately diagnosed and treated for underactivity of the thyroid gland (known as primary hypothyroidism), warn doctors in an editorial published on bmj.com today.
Hypothyroidism is caused by insufficient production of thyroid hormone by the thyroid gland. It affects about three per cent of the population and is usually treated in primary care. Blood tests are essential in confirming the diagnosis of hypothyroidism.
But doctors at the British Thyroid Association are concerned that, in recent years, increasing numbers of patients with and without confirmed thyroid disease have been diagnosed and treated inappropriately with thyroid hormones.
"This is potentially an enormous problem, given that in any one year one in four people in the United Kingdom have their thyroid function checked," they warn.
The Royal College of Physicians recently set out clear guidance for the diagnosis and treatment of primary hypothyroidism in the United Kingdom, so why have these problems arisen, ask the authors?
Hypothyroidism is common and is becoming more prevalent because of increased life expectancy and an ageing population, they explain. Thyroid hormones also affect most organs, so hypothyroidism presents with symptoms that can mimic other conditions. This can lead to an incorrect diagnosis which could expose some patients to the harmful effects of excess thyroid hormones, while other serious conditions may go undiagnosed.
Information available on the internet and media interest in alternative modes of diagnosis and treatment of hypothyroidism, have also caused an increase in requests for inappropriate investigations and non-standard treatments, as well as referrals to non-accredited practitioners, they add.
These factors have led to a rise in awareness and confusion about hypothyroidism, and they have increased the workload in primary care.
The authors stress that, in most cases, the management of primary hypothyroidism is straightforward and should be undertaken in primary care.
But they suggest that if wellbeing is not restored despite normal concentrations of thyroid stimulating hormone, it is important to exclude other conditions as the cause of ongoing symptoms. If no obvious cause is found the patient should be referred to an accredited hospital endocrinologist or general physician.
Contacts:Amit Allahabadia, Secretary, British Thyroid Association, Department of Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UKEmail: amit.allahabadia@sth.nhs.uk

Wenn die Schilddrüse in den Brustkorb wächst...

A 67-year-old woman presented with a 6-month history of dyspnea and dysphagia. Physical examination revealed a small cervical goiter, but the lower poles of the thyroid were not palpable. The serum thyrotropin and free thyroxine levels were normal. Ultrasonography of the neck revealed a large goiter with the right lobe extending into the anterior superior mediastinum; the lower part of the mass was not detectable because of the sternum. Chest radiography (Panel A) showed tracheal deviation (arrows). Cervical and mediastinal computed tomography (Panels B and C, respectively) showed a large goiter (8 by 6 by 10 cm) extending from the laryngeal cartilage into the mediastinum, displacing vascular structures (black arrows) and causing both compression and deviation of the trachea (white arrows). Total thyroidectomy was performed, and histologic examination revealed a multinodular goiter. The patient's symptoms resolved after surgery.

NEJM 360 (13): e19, Figure 1 March 26, 2009

Symptome, Diagnostik und Therapie des Schilddrüsenkrebses

Der Schilddrüsenkrebs (=Schilddrüsenkarzinom) gehört zu den häufigsten endokrinen Tumore.
Die American Thyroid Association Guideline Taskforce hat für diese Krebsart Empfehlungen ausgearbeitet.
Mehr...
Eine Übersicht zu Erkrankungen der Schilddrüse (Struma, kalter Knoten, heisser Knoten, Schilddrüsenkrebs, Hashimoto, Basedow) gibt es hier
Einen Vortrag über Schilddrüsenerkrankungen (Kropf, Knoten, Überfunktion, Unterfunktion) für Patienten gibt es hier.

Chirurgisches Qualitätssiegel

Zum Vergößern Zertifikat anklicken...

Lokschuppen...

Rostock - Warnemünde ist immer eine Reise wert...
Ernst Klar hatte eine klasse Tagung organisiert - ein Höhepunkt der Gesellschaftsabend im Lokschuppen!
Leider hatte Jemand vergessen, im Vorfeld eine faire Kommunikation einzuhalten...und wenn dieser Jemand einen nach drei Sätzen unfreundlich unterbricht, zeigt dies ein eindeutiges Defizit in emotionaler Intelligenz an ...da fällt mir nur eine bestimmte Stelle im Römerbrief ein...

Medizinisches Rätsel

A 23-year-old woman presents with palpitations. Over the past 6 months, she has reported loose stools, a 10-lb (4.5-kg) weight loss despite a good appetite and food intake, and increased irritability. She appears to be anxious and has a pulse of 119 beats per minute and a blood pressure of 137/80 mm Hg. Her thyroid gland is diffusely and symmetrically enlarged to twice the normal size, and it is firm and nontender; a thyroid bruit is audible. She has an eyelid lag, but no proptosis or periorbital edema. The serum thyrotropin level is 0.02 µU per milliliter (normal range, 0.35 to 4.50) and the level of free thyroxine is 4.10 ng per deciliter (normal range, 0.89 to 1.76).
How should she be further evaluated and treated?

Die Antwort gibt es nachfolgend...

graves´ disease - Upload a Document to Scribd

Unterfunktion der Schilddrüse - Hypothyreose

Die Unterfunktion der Schilddrüse ist eine der häufigsten chronischen Erkrankungen der westlichen Welt.
Mehr Informationen gibt es hier

Jod-Defizit...Noch ein langer Weg zu gehen

At the end of June, UNICEF published Sustainable elimination of iodine deficiency, a report on progress since the World Summit for Children of 1990 set the target to eliminate iodine-deficiency disorders worldwide. Iodine is essential for normal growth and development. According to WHO, in 2007, nearly 2 billion individuals had insufficient iodine intake, a third being of school age. Iodine deficiency can have serious consequences, causing abnormal neuronal development, mental retardation, congenital abnormalities, spontaneous abortion and miscarriage, congenital hypothyroidism, and infertility. Later in life, intellectual impairment reduces employment prospects and productivity. Thus iodine deficiency, as the single greatest preventable cause of mental retardation, is an important public-health problem.
Salt-iodisation is a simple cost-effective way of ensuring adequate iodine intake. 120 countries now have salt-iodisation programmes in place, with 34 achieving total salt-iodisation. A recent Lancet Comment discussed problems and solutions to date in Tibet. The number of households in the developing world that use iodised salt has risen from less than 20% in the early 1990s to 70% by 2000. This is a laudable public-health achievement, and success is reflected not only in the figures but also in the maturation of the programmes. Coalitions between international organisations, governments, donors, and salt producers, better education and monitoring, legally enforced political support, and shifts to domestic financing mean the interventions have longevity.
Whilst accomplishments cannot be denied, there is a long way to go. 38 million children are still born every year at risk because of iodine deficiency. There are large differences in the availability and consumption of iodised salt, and in legislation, between countries. Continued vigilance is needed to ensure the positive results seen so far are maintained, while novel approaches may be required in countries where the intake of iodised salt remains low or where improvement has plateaued. The UNICEF report is encouraging, but while there are still children at risk due to a preventable cause, there is no room for complacency.

The Lancet Volume 372, Issue 9633

Schilddrüsenüberfunktion und Schwangerschaft

Scenario

A 35 year old woman develops Graves’ hyperthyroidism (Basedow; the commonest cause of hyperthyroidism) four months after the birth of her second child. She receives treatment with antithyroid drugs for six months. In her third pregnancy she complains of palpitations, excessive sweating, and heat intolerance at 16 weeks’ gestation. Although she experienced these symptoms in previous pregnancies, the current symptoms are much worse.

She is found to be severely hyperthyroid, with raised concentrations of serum free thyroxine (51.7 pmol/l (normal range 9.8-23.1 pmol/l) and free triiodothyronine (19.9 pmol/l (3.5-6.5 pmol/l)) and with suppressed concentrations of thyrotrophin (thyroid stimulating hormone) (<0.02> treated with propylthiouracil, initially 150 mg three times daily, which is reduced eventually to 50 mg twice daily as she becomes euthyroid. Thyrotrophin receptor antibodies are measured at 30 weeks’ gestation and are negative. Propylthiouracil is continued throughout pregnancy and she breast feeds while taking the drug. The drug is stopped two months postpartum; thyroid function is normal three weeks later.

Weitere Informationen gibt es hier

Überfunktion der Schilddrüse und Hypercalcämie

A previously healthy 32-year-old man presented with dyspnea on exertion. Chest radiography showed mediastinal enlargement without pulmonary abnormalities. Magnetic resonance imaging (MRI) showed a mass in the anterior mediastinum with homogeneous gadolinium-diethylenetriamine pentaacetic acid enhancement. An increase in the total serum calcium level (2.98 mmol per liter [normal range, 2.10 to 2.65]) and suppression of thyrotropin (<0.01>

Weiter geht es hier...

5. Tagung der Rhein-Main-AG Minimal-Invasive Chirurgie

Gallengangsverletzungen in der Ära der laparoskopischen Cholecystektomie. Vortrag
Bridging the generation gap. Vortrag
Septischer Schock - Licht am Ende des therapeutischen Tunnels? Vortrag
ABBA - Eine surreale Technik setzt sich durch. Vortrag
MIVAT oder ABBA - das ist hier die Frage! Vortrag
Hyperparathyroidism - the new evolving minimally invasive surgery. Vortrag
Ist die laparoskopische Adrenalektomie wirklich der Goldstandard? Vortrag
Verschlechtert die laparoskopische Technik die Prognose des incidentellen Gallenblasencarcinoms? Vortrag
Die laparoskopische Versorgung der parastomalen Hernie. Vortrag
Spieglein, Spieglein an der Wand - Magenbypass oder Magenband? Vortrag

Neue Erkenntnisse zu Erkrankungen der Schilddrüse

Von den Grundlagen zur Klinik“, so lautete das Motto des Symposiums deutscher Schilddrüsenexperten, das vom 10. bis 13. Oktober 2007 in Heidelberg stattfand. Die Veranstaltung wird alle zwei Jahre von der Deutschen Gesellschaft für Nuklearmedizin, der Deutschen Gesellschaft für Endokrinologie und der Deutschen Gesellschaft für Chirurgie ausgerichtet. Seit 1973 bietet dieser Kongress das größte nationale Forum zur Präsentation wissenschaftlicher und klinischer Daten aus der Thyreologie. Vor allem Ergebnisse, die einen unmittelbaren Nutzen von Erkenntnissen der Grundlagenforschung für die klinische Patientenversorgung belegen, wurden dieses Mal präsentiert.

Eine Zusammenfassung der Tagungsdiskussion gibt es hier.

Minimal Invasive Schilddrüsenchirurgie

Als Chirurgen anfingen, die Gallenblase minimal invasiv zu entfernen, wurden sie erstmal für verrückt erklärt. Ich erinnere mich noch gut an die kontroversen Diskussionen, die damals in den 80iger Jahren geführt wurden. Mittlerweile ist die Technik der Minimal Invasiven Chirurgie aus unserem Alltag nicht mehr wegzudenken - sicher hat das auch damit zu tun, dass eine bestimmte Generation von Chirurgen in Rente gegangen ist.
Die Minimal Invasive Chirurgie der Schilddrüse steht erst am Anfang - und erstaunlicherweise gibt es genau wieder diese emotional geführten Diskussionen...
Ich bin überzeugt, dass sich auch diese Technik durchsetzen wird...

Feinnadel-Aspiration (FNA) von verdächtigen Schilddrüsenknoten

Häufig werden Schilddrüsenknoten punktiert (=FNP), um festzustellen, ob sie bösartig (=Schilddrüsen-Krebs) sind oder nicht.
Wenn bei der Feinnadel-Aspiration keine bösartige Entartung des Knotens festgestellt werden kann, bedeutet das jedoch keineswegs, daß dem so sein muß.
Eine jetzt publizierte Studie kommt zu dem Schluß, daß durch die FNP bis zu einem Drittel an bösartigen Schilddrüsenknoten nicht entdeckt werden.

Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules: a comprehensive literature review.
Y Tee et al
Annals of Surgery 246:714-720, 2007

Zenker'sches Divertikel

Ein 68-jähriger alter Mann wurde wegen zunehmender Schluckbeschwerden und Aufstoßen überwiesen. Mittlerweile konnte er nicht mehr essen oder trinken ohne gleichzeitig husten und spucken zu müssen. Er hatte eine Schilddrüsenhormonmedikation. Die Untersuchung zeigte eine Unterernährung und Myxödeme. Die Blutuntersuchungen bestätigten eine Schilddrüsenunterfunktion. Eine Barium-Röntgenkontrastaufnahme zeigte ein großes Zenker'sches Divertikel (Abbildung A). Der Patient erhielt eine enterale Ernährung und die Schilddrüsenhormontherapie erfolgte über eine Magensonde.

Nach Optimierung des Ernährungs- und Schilddrüsenstatus wurde eine endoskopische Divertikulotomie vorgenommen. Beim Einführen des Divertikuloskops, um die Gewebebrücke zwischen Ösophagus und Divertikel einzustellen, wurde eine Schilddrüsenhormontablette entdeckt, die im Divertikel steckte (Abbildung B). Die Operation und der postoperative Verlauf waren unauffällig. Der Patient befand sich danach in einer normalen Schilddrüsenstoffwechsellage und konnte ohne Probleme schlucken.

S. Alam Hannan, Ghassan Alusi. NEJM Vol 34:e24, June 8, Number 23