Myometrium is a somewhat heterogeneous echo texture

"Therapy for goiter is really very simple"

Every third adult German citizen has pathological changes in the thyroid gland. And: every fourth adult German citizen has lumps in the thyroid gland, every second of those over 45 years of age. This was the result of a nationwide study by the Papillon Thyroid Initiative. More than 100,000 men and women had been examined by ultrasound. However, little has improved since then.

The goal is an even better iodine supply than before: Adults should take in at least 180 to 200 µg iodine per day. In fact, according to the last available figures from 1996, it was only between 111 and 126 µg per day, according to Schumm-Draeger at the Grünwalder talks, which were supported by the company Sanofi-Aventis. That is why Germany was classified as an iodine deficiency area by the WHO in 1998.

How can you diagnose goiter or suspected lump? Functional diagnostics include determining the serum TSH value, said Schumm-Draeger. If the serum TSH value is in the normal range, an overactive thyroid is excluded.

If the TSH level is lowered, the peripheral hormone parameters free thyroxine (fT4) and free triiodide thyronine (fT3) should be determined. Morphological changes in the thyroid gland are diagnosed with sonography. The thyroid volume is measured and the echo texture of the organ (diffuse as well as focal, nodular changes?) Is assessed, according to the endocrinologist.

Drug therapy is advisable if the serum TSH value is in the normal range and the thyroid gland is enlarged in a purely diffuse manner in the sonography. A combination of L-thyroxine and iodide (offered by the company as Thyronajod® Henning) has proven to be particularly effective. In contrast to monotherapy with levothyroxine, goiter relapses occur less frequently after discontinuation of therapy. In addition, the combination is usually better tolerated, explained Schumm-Draeger.

The therapy recommendations of the German Society for Endocrinology are not consistently implemented, the screening study Papillon 3 has shown. In 3,170 medical practices, 31,715 patients were examined who were receiving thyroid hormones or iodine because of nodular or diffuse goiter.

63 percent of the patients received L-thyroxine as monotherapy, another 28 percent received combination therapy (L-thyroxine and iodide). Only 40 percent had a TSH between 0.3 and 1.2 mU / l, as recommended by the DGE. More than 20 percent had pathological TSH values ​​(less than 0.3 or greater than 4.0 mU / l) during pharmacotherapy, reported Schumm-Draeger.

"Goiter therapy is really quite simple," she said. The patients should receive a combination therapy with iodide and L-thyroxine in a ratio of 2 to 1. The TSH value should be between 0.3 and 1.2 mU / l for this treatment. With this combination one can reduce the TSH production, the iodide provides for the iodine supply.