title: [Functional activity of autonomous adenoma in Germany].
abstract: BACKGROUND
  The American (ATA) and the European Thyroid Association (ETA) recommend a thyroid scintiscan for the detection of a suspected autonomy only when serum thyrotropin (TSH) levels are low or suppressed. If ultrasound reveals a thyroid nodule > 1.0 cm and TSH is normal, a fine-needle biopsy is recommended without a preceding scintiscan as the next step. The aim of this prospective study was to evaluate the incidence of reduced or suppressed TSH in 100 autonomous adenoma > 1.0 cm and to clarify, if normal TSH does substantially exclude a focal autonomy. When the study was conducted no data of German patients were available.
  
  
  METHODS
  An unselected group of 496 patients with a nodular goiter was continuously screened by scintiscan in order to detect 100 autonomous adenoma > 1.0 cm for the study. The following investigations were carried out: ultrasound, scintiscan and laboratory tests (fT3, fT4, TSH, TPO-antibodies). The reference range of TSH was 0.4 to 4.0 µU/ml.
  
  
  RESULTS
  21% of patients (100/476) with a nodular goiter had a focal autonomy. 32 % (32/100) of autonomous adenoma revealed a reduced (< 0.4 µU/ml) or completely suppressed TSH, while in 68 % (68/100) normal TSH level were found.
  
  
  CONCLUSIONS
  In Germany autonomous adenoma are still frequent (21 % of all thyroid nodules). Most of them (68 %) reveal normal TSH levels. Our data demonstrate, that there is no relevant connection between TSH level and autonomous adenoma detected by scintiscan. In most cases, TSH is not able to discriminate, whether a nodule is autonomous or not. Biopsy of undetected autonomous nodules should not be performed, as they often show cytological features of follicular neoplasias. In thyroid nodules > 1.0 cm a scintiscan should routinely be performed in primary diagnostics to avoid unnecessary fine-needle biopsy of autonomous adenoma.
authors.affiliation: Endokrinologisch-nuklearmedizinische Praxisgemeinschaft Lüneburg.
authors.forename: D
authors.initials: D
authors.lastname: Graf
authors.forename: B
authors.initials: B
authors.lastname: Helmich-Kapp
authors.forename: S
authors.initials: S
authors.lastname: Graf
authors.forename: F
authors.initials: F
authors.lastname: Veit
authors.forename: N
authors.initials: N
authors.lastname: Lehmann
authors.forename: K
authors.initials: K
authors.lastname: Mann
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012016:Reference Values; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D013972:Thyrotropin / Q000097:blood*; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor; D013972:Thyrotropin