Leitlinienprogramm OnkologieThyroid Cancer

1. Information about this Guideline – Thyroid Cancer

Version 1.2 · September 2026 · AWMF 031-056OL
Leitlinienprogramm Onkologie · Deutsche Krebsgesellschaft · Deutsche Krebshilfe · AWMF

1.1 Editors

The German Guideline Program in Oncology (GGPO) of the Association of the Scientific Medical Societies in Germany (AWMF), the German Cancer Society (DKG), and the German Cancer Aid Foundation (DKH).

1.2 Leading Scientific Societies

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) vertreten durch die Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK)

Deutsche Gesellschaft für Endokrinologie (DGE)

Deutsche Gesellschaft für Nuklearmedizin (DGN)

1.3 Funding of the Guideline

This guideline was funded by German Cancer Aid as part of the GGPO.

1.4 Contact

Office German Guideline Program in Oncology
c/o Deutsche Krebsgesellschaft e. V.
Kuno-Fischer-Straße 8
D-14057 Berlin

leitlinienprogramm@krebsgesellschaft.de
www.leitlinienprogramm-onkologie.de

 

1.5 How to cite

Leitlinienprogramm-Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Thyroid Cancer, Langversion 1.2, 2026, AWMF-Registernummer 031-056OL, https://www.leitlinienprogramm-onkologie.de/leitlinien/schilddruesenkarzinom

1.6 Previous Changes of Version 1.2

Version 1.2 (August 2026):

  • Correction in Chapter 5.8.2.3: Adjustment of the unit of measurement of thyroglobulin values
  • Change in Chapter 8.3.4: Consensus-based Statement 8.20 was changed to Consensus-based Recommendation.
  • Removal of a non-functional URL in Chapter 8.5.2

1.7 Special Comment

Medicine is subject to a continuous development process, so that all information, particularly  in regard to diagnostic and therapeutic procedures, can only reflect the state of knowledge at the time of publication of the guideline. The utmost care has been taken with regard to the recommendations given for therapy and the selection and dosage of medications. Nevertheless, users are advised to consult the package inserts and specialist information provided by the manufacturers and, in case of doubt, to consult a specialist. In the general interest, any discrepancies should be reported to the GGPO editorial team.

The user remains responsible for any diagnostic and therapeutic application, medication, and dosage.

Registered trademarks (protected trade names) are not specifically identified in this guideline. Therefore, the absence of a corresponding reference does not mean that the product name is a free trade name.

The work is protected by copyright in its entirety. Any use outside the provisions of German copyright law without the written consent of the GGPO editorial team is prohibited and punishable by law. No part of the work may be reproduced in any form without the written permission of the GGPO editorial team. This applies in particular to reproductions, translations, microfilming and the storage, use, and exploitation in electronic systems, intranets, and the Internet.

1.8 Objectives of the GGPO

The German Association of Scientific Medical Societies (AWMF), the German Cancer Society (DKG), and the German Cancer Aid (Deutsche Krebshilfe) have set themselves the goal of jointly promoting and supporting the development, updating and use of scientifically based and practicable guidelines in oncology with the German Guideline Program in Oncology (GGPO). This program is based on the medical-scientific findings of the specialist societies and the DKG, the consensus of medical experts, users and patients, as well as the AWMF guidelines and the technical support and funding provided by German Cancer Aid. In order to reflect the current state of medical knowledge and take medical progress into account, guidelines must be regularly reviewed and updated. The application of the AWMF guidelines should form the basis for the development of high-quality oncological guidelines. As guidelines are an important tool for quality assurance and quality management in oncology, they should be incorporated into everyday care in a targeted and sustainable manner. Active implementation measures and evaluation programs are therefore an important part of the promotion of the oncology guideline program. The aim of the program is to create professional and, in the medium term, financially secure conditions for the development and provision of high-quality guidelines in Germany. These high-quality guidelines not only serve the structured transfer of knowledge, but can also be used to shape the structures of the healthcare system. Examples include evidence-based guidelines as a foundation for creating and updating disease management programs or the use of quality indicators extracted from guidelines as part of the certification of organ tumor centers.

1.9 Additional Documents relating to this Guideline

This long version of the guideline is currently available. A short version and a patient guideline (lay version of the guideline) are still being developed. All guideline documents are available on the following websites:

1.10 Composition of the Guideline Group

1.10.1 Coordination and Reaction

Coordination (without voting rights): 
Prof. Dr. Dr. Dr. h. c. Andreas Bockisch, Essen

Composition of the coordination group:

  • Prof. Dr. Dr. Dr. h. c. Andreas Bockisch
  • Prof. Dr. Thomas Lauenstein
  • Prof. Dr. Kerstin Lorenz
  • Harald Rimmele
  • Prof. Dr. Matthias Schmidt
  • Prof. Dr. Matthias Schott

Guidelines secretariat at the German Society of Nuclear Medicine

  • Götz Jonas
  • Tobias Fabiunke

1.10.2 Involved Professional Societies and Organisations

Table 1: Participating professional associations and organizations

Beteiligte Fachgesellschaften und OrganisationenMandatsträger
Arbeitsgemeinschaft Bildgebung in der Onkologie der DKG (ABO)Prof. Dr. James Nagarajah
Prof. Dr. Thorsten Persigehl
Arbeitsgemeinschaft für Psychoonkologie in der DKG (PSO)Dr. Matthias Büttner
Arbeitsgemeinschaft Onkologische Rehabilitation und Sozialmedizin in der DKG (AGORS)Dr. Timm Dauelsberg
Dipl.-Med. Gerhard Faber
Arbeitsgemeinschaft Palliativmedizin in der DKG (APM)Prof. Dr. Markus Deckert
Prof. Dr. Markus Meissner
Arbeitsgemeinschaft Radiologische Onkologie in der DKG (ARO)Prof. Dr. Thomas Brunner
Prof. Dr. Ursula Nestle
Bundesverband Schilddrüsenkrebs Ohne Schilddrüse lebenHarald Rimmele
Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV)Prof. Dr. Cornelia Dotzenrath
Prof. Dr. Thomas Musholt
Prof. Dr. Christian Scheuba
Prof. Dr. Theresia Weber
Deutsche Gesellschaft für Endokrinologie (DGE)Prof. Dr. Joachim Feldkamp
Prof. Dr. Karin Frank-Raue
Prof. Dr. Dr. Dagmar Führer-Sakel
Prof. Dr. Friedhelm Raue
Prof. Dr. Christine Spitzweg
Deutsche Gesellschaft für Humangenetik (GfH)Dr. Bernd Auber
Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie (DGHO)PD Dr. Wilfried Eberhardt
Deutsche Gesellschaft für Innere Medizin (DGIM)PD Dr. Wilfried Eberhardt
Deutsche Gesellschaft für Kinderendokrinologie und - diabetologie (DGKED)Prof. Dr. Christian Denzer
Deutsche Gesellschaft für Medizinische PhysikDr. Heribert Hänscheid
Deutsche Gesellschaft für Nuklearmedizin (DGN)Prof. Dr. Wolfgang Burchert
Prof. Dr. Rainer Görges
Prof. Dr. Hubertus Hautzel
Prof. Dr. Michael Kreißl
Prof. Dr. James Nagarajah
PD Dr. Simone Schenke
Deutsche Gesellschaft für Palliativmedizin (DGP)Prof. Dr. Markus Deckert
Prof. Dr. Markus Meissner
Deutsche Gesellschaft für Pathologie (DGP)Prof. Dr. Kurt Werner Schmid
PD Dr. Dr. Udo Siebolts
Deutsche Gesellschaft für Phoniatrie und Pädaudiologie (DGPP)Prof. Dr. Michael Fuchs
Prof. Dr. Annerose Keilmann
Deutsche Gesellschaft für Radioonkologie (DEGRO)Prof. Dr. Thomas Brunner
Prof. Dr. Ursula Nestle
Deutsche Gesellschaft für Rehabilitationswissenschaften (DGRW)Dr. Timm Dauelsberg
Dipl.-Med. Gerhard Faber
Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM)Prof. Dr. Jörg Bojunga
Deutsche Röntgengesellschaft (DRG)Prof. Dr. Thomas Lauenstein
Fachverband für StrahlenschutzProf. Dr. Christoph Reiners
Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH)PD Dr. Antje Redlich
Schilddrüsen-Liga DeutschlandProf. Dr. Michael Cordes

The German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC) contributed intensively to the consultation phase and explicitly endorses the guideline.

1.10.3 Arbeitsgruppen

Table 2: Arbeitsgruppen

Arbeitsgruppe

Mitglieder der Arbeitsgruppe (AG-Leiter fett markiert)

1. DTC and PDTC

Dagmar Führer-Sakel, Thomas Musholt, Matthias Schmidt,

2. MTC

Markus Luster, Friedhelm Raue, Christian Scheuba,

3. ATC

Peter Bartenstein, Kerstin Lorenz, Vera Tiedje,

4. Overview: pathology/genetics

Rainer Görges, Stefan Karger, Kerstin Lorenz,

5a Pre-/peritherapeutic initial diagnostics

Joachim Feldkamp, Michael Kreißl, Jochen Schabram,

5b Diagnostics and differential therapeutic consequences in cases of suspected recurrence and suspected progression

Joachim Feldkamp, Michael Kreißl, Norbert Niederle,

6a Initial surgical therapy

Cornelia Dotzenrath, Martin Freesmeyer, Wolfram Karges,

6b Surgical therapy at recurrence or persistance

Martin Freesmeyer, Wolfram Karges, Theresia Weber,

7. Follow-up care including substitution and suppressive medication

Holger Amthauer, Matthias Schott, Dietmar Simon,

8. Drug therapy at recurrence or persistence

Katharina Holzer, James Nagarajah, Christine Spitzweg,

1.10.4 Other Patient Involvement (without voting rights)

Prof. Dr Andreas Müller (DGHNO-KHC) provided advice on respiratory tract and laryngeal issues, including associated functional disorders, in the context of the treatment of thyroid cancer.

The following professional societies/organizations have explicitly refrained from participating in the guideline:

  • Deutsche Gesellschaft für Allgemein- und Familienmedizin e. V. (DEGAM)
    German Society for General Practice and Family Medicine
  • Deutsche Gesellschaft für Pflegewissenschaft e. V. (DGP)
    German Society for Nursing Sciences

The following professional societies/organizations did not nominate any representatives in response to the request for participation in the guideline:

  • Arbeitsgemeinschaft für Supportive Maßnahmen in der Onkologie (AGSMO) der Deutschen Krebsgesellschaft (DKG)
    Working Group for Supportive Measures in Oncology of the German Cancer Society
  • Die Schmetterlinge e. V.

1.10.5 Patient Involvement

Representatives of the Bundesverband Schilddrüsenkrebs Ohne Schilddrüse leben (Federal Thyroid Cancer Association Living without a thyroid) -  were directly involved in the development and coordination of the recommendations throughout the entire drafting process.

1.10.6 Methodological Support

 Methodical support is provided by:

  • Evidence-based Medicine | Cochrane Haematology (Prof. Dr. Nicole Skoetz)
  • Office of the GGPO (Dr. Markus Follmann, Thomas Langer, Gregor Wenzel)
  • Association of the Scientific Medical Societies in Germany AWMF - Institute for Medical Knowledge Management  (Dr. Monika Nothacker)

1.11 Abkürzungsverzeichnis

Table 3: Abbreviations

AbkürzungenErläuterungen
AG

Working group

AJCC

American Joint Committee on Cancer

AMES

Age, metastases, extent, size (risk classification system)

ARFI

Acoustic Radiation Force Impulse Imaging

ATA

American Thyroid Association

ATC

Anaplastic thyroid cancer

AUC

Area under the curve

AWMF

Association of the Scientific Medical Societies

ÄZQ

German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin)

BTA

British Thyroid Association

CAEK

German Surgical Workgroup for Endocrinology (Chirurgische Arbeitsgemeinschaft Endokrinologie)

CEA

Carcinoembryonic antigen

CCD

Color-coded duplex sonography

CCDS

Color-coded Doppler sonography

CEUS

Contrast-enhanced ultrasound

CI

Confidence interval

CIONM

Continuous intraoperative neuromonitoring

CPS

Combined positive score

Ctn

Calcitonin

DHGTC

Differentiated high-grade thyroid cancer

DKG

German Cancer Society

DNA

Deoxyribonucleic acid

DSR

Desmoplastic stromal reaction

DTC

Differentiated thyroid cancer

EANM

European Association of Nuclear Medicine

EBRT

External beam radiotherapy

EC

Expert consensus

ECOG

Eastern Cooperative Oncology Group

EMA

European Medicines Agency

ESES

European Society of Endocrine Surgeons

ESMO

European Society of Medical Oncology

FKDS

see CCD

FMTC

Familial medullary thyroid cancer

FNA

Fine-needle aspiration

FNAC

Fine-needle aspiration cytology

FND

Follicular nodular disease

FNMTC

Familial non-medullary thyroid cancer

FTC

Follicular thyroid carcinoma

HADS

Hospital Anxiety and Depression Scale

HR

Hazard ratio

IC

Immune cells

IMRT

Intensity modulated radiotherapy

IONM

Intraoperative neuromonitoring

LN

Lymph node(s)

MEN2

Multiple endocrine neoplasia, type 2

MIFTC

Minimally invasive follicular thyroid carcinoma

MKI

Multi-targeted tyrosin kinase inhibitors

MRI

Magnetic resonance imaging

MTC

Medullary thyroid cancer

NCDB

National Cancer Database (USA)

NIFTP

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features

NPV

Negative Predictive Value

NTCTCS

National Thyroid Cancer Therapy Cooperative Study Group

ORR

Overall response rate

OS

Overall survival

PDL

Programmed-death ligand

PERCIST

PET Response Criteria In Solid Tumors

PPV

Positive predictive value

PTC

Papillary thyroid carcinoma

PTC-CCV

Columnar cell variant of PTC

PTC-DSV

Diffuse sclerosing variant of papillary thyroid cancer

PTC-HV

Hobnail variant of PTC

PTC-OV

Oncocytic variant of PTC

PTC-SV

Solid variant of PTC

PTC-TCV

Tall-cell variant of PTC

PTMC

Papillary thyroid microcarcinoma

QI

Quality indicator

RECIST

Response Evaluation Criteria in Solid Tumors

RID

Radioactive iodine diagnostics

RIT

Radioactive iodine therapy

SGB

German Social Code

SSTR

Somatostatin receptor

SUV / SUVmax

Standardized uptake value / ...maximum

SWE

Shear-wave elastography

TgAb

Thyroglobulin antibodies

TDS

Tumor disposition syndrome

THW

Thyroid hormone withdrawal

TIRADS

Thyroid Imaging Reporting and Data Systeme

TKI

Tyrosine kinase inhibitor

TPS

Tumor proportion score

TSH

Thyroid-stimulating hormone

UICC

Union Internationale Contre le Cancer (eng.: Union for International Cancer Control)

WG

Working group

WHO

World Health Organization

WI-FTC

Widely invasive follicular thyroid carcinoma