DÄ internationalArchive16/2014Benefit of Follow-up not Confirmed
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I disagree with the key message that sonography is used too rarely to monitor thyroid nodules not managed surgically (1). As the authors correctly state, about 20% of the population have at least one thyroid nodule which most are not aware of and live well without control examinations. Attempting to detect and control all nodules would overstretch the healthcare system.

The positive predictive value of thyroid ultrasound for malignancy is low (8–20%) given the extremely low pretest probability (2). This is certainly one reason for the number of diagnostic surgical procedures, which were criticized as excessive in the article. There is no evidence for the benefit of follow-up examinations in nodules that were initially assessed as non-malignant. We do not know which follow-up intervals are appropriate and when to stop screening stop altogether.

Every year, about 5500 persons in Germany develop thyroid cancer, which has an excellent prognosis for the most common subtypes (3). Morphological thyroid investigations should be restricted to symptomatic patients or patients with impaired thyroid function, until evidence from high quality studies with long term follow-up is available to show that asymptomatic nodules require medical attention. Most of the 16 000 000 persons with asymptomatic thyroid nodules will be grateful if a problem that is not one does not turn them into chronically ill patients, and if the limited resources are used for more relevant health problems.

DOI: 10.3238/arztebl.2014.0287b

Prof. Dr. med. Jean-François Chenot, MPH

Abteilung Allgemeinmedizin, Institut für Community

Universitätsmedizin Greifswald, jchenot@uni-greifswald.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Wienhold R, Scholz M, Adler JB, Günster C, Paschke R: The management of thyroid nodules—a retrospective analysis of health insurance data. Dtsch Arztebl Int 2013; 110(49): 827–34. VOLLTEXT
2.
Bonavita JA, Mayo J, Babb J, Bennett G, Oweity T, Macari M, Yee J: Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol 2009; 193: 207–13 CrossRef MEDLINE
3.
Robert Koch Institut. Gesundheitsberichterstattung des Bundes. Krebs in Deutschland 2009/2010, 9th edition. 2013. www.krebsdaten.de/Krebs/DE/
Content/Publikationen/Krebs_in_Deutschland/krebs_in_deutschland_node.html
(last accessed on 5.3.2014)
1.Wienhold R, Scholz M, Adler JB, Günster C, Paschke R: The management of thyroid nodules—a retrospective analysis of health insurance data. Dtsch Arztebl Int 2013; 110(49): 827–34. VOLLTEXT
2.Bonavita JA, Mayo J, Babb J, Bennett G, Oweity T, Macari M, Yee J: Pattern recognition of benign nodules at ultrasound of the thyroid: which nodules can be left alone? AJR Am J Roentgenol 2009; 193: 207–13 CrossRef MEDLINE
3.Robert Koch Institut. Gesundheitsberichterstattung des Bundes. Krebs in Deutschland 2009/2010, 9th edition. 2013. www.krebsdaten.de/Krebs/DE/
Content/Publikationen/Krebs_in_Deutschland/krebs_in_deutschland_node.html
(last accessed on 5.3.2014)

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