1. Information about this Guideline – Thyroid Cancer
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
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:
- AWMF (https://register.awmf.org/de/leitlinien/detail/031-056OL)
- German Guideline Program in Oncology (https://www.leitlinienprogramm-onkologie.de/leitlinien/schilddruesenkarzinom)
- Websites of the participating specialist societies (DGN, DGAV, DGE)
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 Organisationen | Mandatsträger |
|---|---|
| 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 leben | Harald 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 Physik | Dr. 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 Strahlenschutz | Prof. Dr. Christoph Reiners |
| Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) | PD Dr. Antje Redlich |
| Schilddrüsen-Liga Deutschland | Prof. 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
| Abkürzungen | Erläuterungen |
|---|---|
| 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 |