Correspondence (letter to the editor): Questions Remain Unanswered

Why was the volume reduction owing to combination treatment cited in such detail—where is the benefit for asymptomatic patients? Why was iodine not recommended as first-line treatment?

The standard follow-up interval is set at 6–18 months—why not gradually longer intervals? What is the number needed to screen (NNS) with regard to preventable, high-risk disease courses?

Under the heading “Laboratory tests,” you recommend general calcitonin measurements; under “Clinical follow-up and further care after treatment,” you write: “History-taking, physical examination, ultrasonography, and TSH measurement generally constitute an adequate clinical follow-up.” Is measuring calcitonin therefore useful only in the initial consultation for a nodule? Or in every consultation? What would be the NNS for this measure, and what would be the costs?

In view of the cited prevalence this would involve one-fifth of the adult population. In my opinion, it is not enough to cite guidelines from medical specialty societies in this context. One would expect that in a review article that addresses all doctors, any recommendations would at least briefly have discussed aspects of benefits (NNS) and harms (number needed to harm, NNH).