[Thyroid disorders]

In Germany, thyroid disorders have a long history. A sufficient iodine supply has been achieved in recent years in Germany. Thyroid nodules are frequent and mostly benign findings. Autonomous adenomas are not self-curable findings and require a definitive therapy, especially in the case of concomitant functional abnormalities (subclinical or overt hyperthyroidism). Graves' disease is the other most frequent cause of overt hyperthyroidism. In Germany, Graves' disease is treated with thyrostatic medication usually over 1-1 1/2 years, resulting in a definitive cure in about 50% of patients. In the case of therapy failure or high risk of relapse according to initial findings or complications under thyrostatic medication (leucopenia), definitive treatment mostly by way of radioactive iodine-131 is advised. Radioiodine therapy is usually well tolerated with minimal side effects and is not associated with risks such as laryngeal nerve palsy and hypoparathyroidism. Alternatively, surgical treatment is indicated in case of suspected malignancy or large thyroid volumes with relevant tracheal compression. Hashimoto's thyroiditis is the most frequent reason for hypothyroidism requiring levothyroxine substitution. In Germany, about 3500 women and 1500 men are diagnosed with papillary or follicular thyroid carcinoma each year which can be cured in the vast majority of patients. Less than 10% develop metastases after initial thyroidectomy and ablative radioiodine therapy. These patients can be treated with further therapy cycles of radioiodine. In the case of development of dedifferentiated iodine-negative, FDG-PET-positive metastatic disease treatment options are limited. In this situation, tyrosinkinase-inhibitors are a new treatment option which are being evaluated in current and prospective randomised controlled trials. Thyroid carcinoma (C73) is the most frequent reason for medical pensions because of thyroid disease. The rare anaplastic thyroid carcinoma is one of the most malignant tumours overall being usually fatal within a few months after diagnosis.