Dr. Ralf Paschke


Ralf Paschke served as Division Head of Endocrinology at the University of Calgary and Zone Head of Endocrinology in Calgary from July 2015 to May 2019. In November 2015, he was elected as the chair of the provincial endocrine tumour team in Alberta.

Ralf Paschke spent 4 years as a Heisenberg Professor in a molecular laboratory in the Institute of Interdisciplinary Research at the Universite Libre in Brussels, Belgium working on the molecular etiology of hot thyroid nodules and the mechanism of activation of the TSHR. He was appointed Professor of Internal Medicine and Endocrinology at the University of Leipzig in 1995. His major research interests include thyroid cancer, thyroid nodules, molecular diagnostics of indeterminate thyroid nodule molecular fine needle cytologies, the TSH-receptor and diseases caused by TSH-receptor mutations. He trained in Pathology, Internal Medicine and Endocrinology in the university hospitals of Frankfurt, Mannheim/Heidelberg and Muenster. He served for 9 years as Director of the Medical Department III at Leipzig University with the sections Endocrinology, Diabetes and Nephrology. He was also the coordinator for endocrine research and deputy chairman of the Interdisciplinary Centre for Clinical Research at the University of Leipzig, Germany. He is the author of more than 350 original journal articles, co-author of several thyroid guidelines and serves on the editorial boards of several journals including Thyroid and repeatedly the JCEM.

He implemented a stratified thyroid nodule ultrasound malignancy risk assessment in Calgary 9/2017 together with Paula Seal (EFW Radiology) and Chris Symonds (Endocrinology). The malignancy risks for Bethesda thyroid nodule FNAC categories in Calgary were determined together with Sana Ghaznavi and Moosa Khalil. A lobectomy proposal for patients with thyroid nodules or thyroid cancer was implemented 4/2017 and revised 10/2017 with the thyroid surgeons in Calgary. It led to 20% lobectomies for thyroid cancer since 4/2017 in Calgary. A further revised version was adopted by the provincial interdisciplinary endocrine tumour team as provincial lobectomy proposal. Together with the Calgary Primary Care Networks (PCNs) Ralf Paschke implemented a thyroid nodule diagnostic pathway 3/2018. The Calgary ThyroSPEC™ panel for the molecular FNA diagnostics of indeterminate thyroid nodules covering 117 point mutations and 23 rearrangements invented by R. P. and Markus Eszlinger was implemented by Alberta Precision Laboratories and Alberta Health Services 7/2020 as a routine reimbursed reflex test for indeterminate thyroid nodule FNA cytologies. With prospective databases for patients with thyroid nodules and thyroid cancer the health outcomes of these patients are evaluated to further improve diagnostics and treatment.

Ralf Paschke chaired the European Thyroid Association guideline task forces generating the guideline for molecular diagnostics of indeterminate thyroid nodule FNA cytologies and the guideline for the management of non-autoimmune hyperthyroidism. He was involved as a coauthor in three updates of the thyroid nodule guideline by the American Association of Clinical Endocrinologists, Assoziazione Medici Endocrinolgi, and European Thyroid Association and the European Thyroid Association guideline task force for cervical ultrasound scan and ultrasound guided techniques in the postoperative management of patients with thyroid cancer. He is a member of the current European Association guideline task force for a thyroid nodule guideline.

Based on his previous experience as a local PI for the Lenvatinib and Sorafenib phase 3 studies and the Astra study investigating Selumetinib for the adjuvant radioiodine treatment of patients with high recurrence risk thyroid cancers he continued to focus his clinical work on the treatment of radioiodine resistant metastatic thyroid cancer. After the successful re-sensitization treatment of the first patient in Calgary, many further patients have been treated for radioiodine re-sensitization in Calgary. With the help of Markus Eszlinger whole exome sequencing analysis and with John McIntyre and Faisal Khan targeted Next Generation Sequencing of the primary tumours was used to predict success or failure of this approach and to identify the targets for NTRK and RET inhibitors and the off-label use of other tyrosine kinase inhibitors to better stratify patients with radioiodine resistant progressive metastatic thyroid cancer for new and individually targeted drugs.

The Department of Medicine Annual Report 2018-2019 features the Thyroid Cancer Group’s work on thyroid nodules and thyroid cancer clinical pathway.

Arnie Charbonneau Cancer Institute

Biochemistry and Molecular Biology