ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

Diagnostic and Therapeutic Approaches to Thyroid Nodules in Turkey
Türkiye’de Tiroid Nodüllerine Tanı ve Tedavi Yaklaşımları
Received Date : 29 Sep 2019
Accepted Date : 23 Jan 2020
Available Online : 05 Feb 2020
Doi: 10.25179/tjem.2019-71633 - Makale Dili: EN
Turk J Endocrinol Metab 2020;24:47-54
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: This study aimed to evaluate the approaches to thyroid nodules adopted by various specialists and centers in Turkey. Material and Methods: The questionnaire designed by Ralf Paschke for International Thyroid Congress (2010) was provided to 400 (264 general surgeons, 58 endocrine surgeons, and 78 endocrinologists) physicians from Turkey. Education and research hospitals (n=110), state hospitals (n=84), university hospitals (n=122), and private hospitals (n=84) were included. An index case was provided and questions regarding diagnostic and therapeutic/follow-up strategies were asked. Results: The index case was a 35-year-old man presented with swallowing discomfort. His thyroid-stimulating hormone level was 0.5 mIU/L. Thyroid ultrasonography (US) revealed a 13 mm right nodule (RN) and an 18 mm left nodule (LN). The most frequently queried information by physicians about the case was the result of fine needle aspiration biopsy (FNAB) (38.5%) and scintigraphy+FNAB (25.5%). Routine calcitonin measurement was advised by 33.5% of specialists. US and scintigraphy were detailed as; showed intranodular flow, microcalcification in the solid, and normoactive RN and solid hypoechoic, and hypoactive for the LN. FNAB was recommended by 68.5% of specialists for both nodules. Surgery without FNAB was recommended by 9% (n=36) of specialists, mainly by general surgeons (n=32). Specialists from private hospitals recommended surgical management for benign nodules, more frequently than state and university hospitals (p<0.01). Conclusion: Not only invasive and noninvasive diagnostic tests but also the treatment and follow- up strategies varied among general surgeons, endocrine surgeons, and endocrinologists in Turkey. The surgical approach for benign nodules was more frequently preferred in private hospitals.
ÖZET
Amaç: Bu çalışmada, Türkiye’de farklı merkez ve uzmanlık alanlarından hekimlerin tiroid nodüllerine yaklaşımlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Uluslararası Tiroid Kongresi (2010) için Ralf Paschke tarafından tasarlanan anket, Türkiye’de 400 (264 genel cerrah, 58 endokrin cerrah ve 78 endokrinolog) uzman hekime uygulandı. Eğitim ve araştırma hastaneleri (n=110), devlet hastaneleri (n=84), üniversite hastaneleri (n=122) ve özel hastaneler (n=84) dâhil edildi. İndeks bir hasta verildi ve tanı, tedavi/takip stratejilerine ilişkin sorular soruldu. Bulgular: İndeks olgu 35 yaşında, yutma güçlüğü ile başvuran erkek hastaydı. Tiroid stimüle edici hormon (TSH) düzeyi 0.5 mIU/mL idi. Tiroid ultrasonografi (USG)’sinde sağda 13 mm ve solda 18 mm nodül mevcuttu. Uzmanların hasta hakkında en sık öğrenmek istediği bilgiler, ince iğne aspirasyon biyopsisi sonucu (İİAB) (%38,5) ve sintigrafi+İİAB (%25,5) sonuçlarıydı. Rutin kalsitonin ölçümü uzmanların %33,5’i tarafından önerildi. USG ve sintigrafi; sağ normoaktif solid nodülde mikrokalsifikasyon ve intranodüler kanlanma ve sol hipoaktif nodülde hipoekojenite olarak detaylandırıldı. Her 2 nodül için İİAB, uzmanların %68,5’i tarafından önerildi. İİAB yapılmadan cerrahi, uzman hekimlerin %9’u (n=36) tarafından ve çoğunlukla genel cerrahlarca (n=32) önerildi. Özel hastanelerden uzmanlar, benign nodüller için cerrahi yaklaşımı, devlet ve üniversite hastanelerine göre daha sık önerdi (p<0.01). Sonuç: Türkiye’de hem girişimsel/girişimsel olmayan tanısal testler hem de tedavi/takip stratejileri genel cerrahlar, endokrin cerrahlar ve endokrinologlar arasında değişkenlik göstermektedir. Benign nodüllerin tedavisinde cerrahi yaklaşım özel hastanelerde daha sık tercih edilmektedir.
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