Schilddrüsenknoten und Schilddrüsenkarzinom Schilddrüsenknoten sind in Deutschland weiterhin sehr häufig und stellen sowohl eine diagnostische als auch eine therapeutische Herausforderung dar. In ihnen kann sich eine Reihe von verschiedenen Krankheitsbildern manifestieren. Diese reichen von der funktionellen Autonomie über die symptomatische Knotenstruma bis hin zum Schilddrüsenkarzinom. In jüngerer Vergangenheit hat es hierzu neue Entwicklungen gegeben, die die Differentialdiagnostik erleichtern. Auch beim Schilddrüsenkarzinom konnten in den letzten Jahren viele neue Erkenntnisse gewonnen werden. Insbesondere wird die derzeit in Entwicklung befindliche interdisziplinäre S3-Leitlinie „Schilddrüsenkarzinom“, zugeschnitten auf die deutschen Verhältnisse, ein wichtiger und hilfreicher Leitfaden für die Behandlung des häufigsten endokrinen Malignoms sein. Gegenwärtige interdisziplinäre Behandlungsstrategien und Ausblicke auf zukünftige Therapieoptionen waren ein wichtiges und zentrales Thema der Veranstaltung „Schilddrüse 2021“ in Mannheim. Aus dem Inhalt: - Neues zur Epidemiologie von Schilddrüsenknoten und Schilddrüsenkarzinom - Schilddrüsentumorzellen im Weltraum: Was machen die da? - Lokalablative Therapie der Schilddrüse/Update zur S3-Leitlinie - Möglichkeiten der Schilddrüsendiagnostik mit Roboter und KI - Wie viel und welchen Halsultraschall braucht es bei Schilddrüsenknoten und beim Schilddrüsenkarzinom? - Leicht erniedrigtes bzw. niedrig normales TSH – therapiebedürftig? Was sagt die Evidenz?

Abstract: Purpose: Pre-operative assessment of thoracic lymphonodal (LN) involvement in patients with lung cancer (LC) is crucial when choosing the treatment modality. Visual assessment of F-18-FDG-PET/CT (PET/CT) is well established, however, there is still a need for prospective quantitative data to differentiate benign from malignant lesions which would simplify staging and guide the further implementation of computer-aided diagnosis (CAD). Methods: In this prospective study, 37 patients with confirmed lung cancer (m/f = 24/13; age: 70 [52-83] years) were analyzed. All patients underwent PET/CT and quantitative data (standardized uptake values) were obtained. Histological results were available for 101 thoracic lymph nodes. Quantitative data were matched to determine cut-off values for delineation between benign vs. malignant lymph nodes. Furthermore, a scoring system derived from these cut-off values was established. Statistical analyses were performed through ROC analysis. Results: Quantitative analysis revealed the optimal cut-off values (p

Abstract: Notwithstanding regulatory approval of lenvatinib and sorafenib to treat radioiodine-refractory differentiated thyroid carcinoma (RAI-R DTC), important questions and controversies persist regarding this use of these tyrosine kinase inhibitors (TKIs). RAI-R DTC experts from German tertiary referral centers convened to identify and explore such issues; this paper summarizes their discussions. One challenge is determining when to start TKI therapy. Decision-making should be shared between patients and multidisciplinary caregivers, and should consider tumor size/burden, growth rate, and site(s), the key drivers of RAI-R DTC morbidity and mortality, along with current and projected tumor-related symptomatology, co-morbidities, and performance status. Another question involves choice of first-line TKIs. Currently, lenvatinib is generally preferred, due to greater increase in progression-free survival versus placebo treatment and higher response rate in its pivotal trial versus that of sorafenib; additionally, in those studies, lenvatinib but not sorafenib showed overall survival benefit in subgroup analysis. Whether recommended maximum or lower TKI starting doses better balance anti-tumor effects versus tolerability is also unresolved. Exploratory analyses of lenvatinib pivotal study data suggest dose-response effects, possibly favoring higher dosing; however, results are awaited of a prospective comparison of lenvatinib starting regimens. Some controversy surrounds determination of net therapeutic benefit, the key criterion for continuing TKI therapy: if tolerability is acceptable, overall disease control may justify further treatment despite limited but manageable progression. Future research should assess potential guideposts for starting TKIs; fine-tune dosing strategies and further characterize antitumor efficacy; and evaluate interventions to prevent and/or treat TKI toxicity, particularly palmar-plantar erythrodysesthesia and fatigue