Calcitonin screening in patients with thyroid nodules

2012 ◽  
Vol 51 (06) ◽  
pp. 228-233 ◽  
Author(s):  
C. Kobe ◽  
M. Schmidt ◽  
D. Kahraman ◽  
G. Malchau ◽  
M. Faust ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Autoimmune Thyroid Disease ◽  
Thyroid Nodules ◽  
Medullary Thyroid Cancer ◽  
Solid Phase ◽  
Thyroid Disorders ◽  
Medullary Thyroid ◽  
Autoimmune Thyroid ◽  
Chemiluminescent Immunoassay ◽  
Calcitonin Screening

Summary Aim: The positive predictive value (PPV) of a slightly elevated basal calcitonin (CT) for the diagnosis of medullary thyroid cancer (MTC) is still under debate. Patients, methods: A total of 11 270 patients with thyroid nodules underwent calcitonin screening. Patients with known elevation of CT, renal insufficiency, bacterial infection, alcohol abuse, protonpump inhibitor therapy or autoimmune thyroid disease were excluded from further analysis. Serum CT was determined by the solid-phase, enzyme-labeled, two-site chemiluminescent immunoassay Immulite 2000. If possible, a pentagastrin test was done to differentiate cases of hypercalcitoninaemia. Results: Hypercalcitoninsemia was found in 32 patients. 20 patients underwent surgery. In 10 patients a MTC was found. The PPV of hyper calcitoninaemia for MTC was 31%. The PPV increased to 50% for those patients who underwent surgery (10/20). A subgroup of 26 patients presented with basal CT between 13 and 50 pg/ml, 14 of them underwent surgery, in 4 cases evidence of MTC was revealed. This resulted in a PPV of 15% (4/26), although the value increased to 28% when only surgically treated patients were considered (4/14). Conclusion: Taking all clinical data into account, calcitonin screening has an acceptable PPV for medullary thyroid cancer in patients with thyroid nodules. Therefore, we recommend calcitonin screening in centers for thyroid disorders.

scholarly journals Calcitonin testing for detection of medullary thyroid cancer in people with thyroid nodules

2020 ◽  
Author(s):  
Hans HG Verbeek ◽  
Jan Willem B de Groot ◽  
Wim J Sluiter ◽  
Anneke C Muller Kobold ◽  
Edwin R van den Heuvel ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Medullary Thyroid Cancer ◽  
Medullary Thyroid

scholarly journals Sporadic hypercalcitoninemia: clinical and therapeutic consequences

2009 ◽  
Vol 16 (1) ◽  
pp. 243-253 ◽  
Author(s):  
C Scheuba ◽  
K Kaserer ◽  
A Moritz ◽  
R Drosten ◽  
H Vierhapper ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Medullary Thyroid Cancer ◽  
Germ Line ◽  
Daily Practice ◽  
Cell Hyperplasia ◽  
Medullary Thyroid ◽  
Node Metastases ◽  
Calcitonin Screening

‘Calcitonin screening’ is not accepted as the standard of care in daily practice. The clinical and surgical consequences of ‘calcitonin screening’ in a series of patients with mildly elevated basal calcitonin and pentagastrin stimulated calcitonin levels are presented. 260 patients with elevated basal (>10 pg/ml) and stimulated calcitonin levels (>100 pg/ml) were enrolled in this prospective study. None of the patients was member of a known medullary thyroid carcinoma family. Thyroidectomy and bilateral central and lateral neck dissections were performed. Testing for the presence of germ-line mutations was performed in all patients. Histological and immunohistochemical findings were compared with basal and stimulated calcitonin levels. All patients were subsequently followed biochemically. C-cell hyperplasia (CCH) was found in 126 (49%) and medullary thyroid cancer was found in 134 (51%) patients. RET proto-oncogen mutations were documented in 22 (8%) patients (medullary thyroid cancer:18, CCH:4). In 56 (46%) of 122 patients, sporadic CCH was classified neoplastic (‘carcinoma in situ’). Of 97 (72%; 10 with hereditary medullary thyroid cancer) had pT1 (International Union against Cancer recommendations 2002) and 33 (25%) had pT2 or pT3 and 4 (3%) pT4 tumors. Of 39 (29.1%) had lymph node metastases. 106 (79.1%; 15 (38.5%) with lymph node metastases) patients were cured. Evaluation of basal and stimulated calcitonin levels enables the prediction of medullary thyroid cancer. All patients with basal calcitonin >64 pg/ml and stimulated calcitonin >560 pg/ml have medullary thyroid cancer. Medullary thyroid cancer was documented in 20% of patients with basal calcitonin >10 pg/ml but <64 pg/ml and stimulated calcitonin >100 pg/ml but <560 pg/ml.

scholarly journals A Genomic Alternative to Identify Medullary Thyroid Cancer Preoperatively in Thyroid Nodules with Indeterminate Cytology

Thyroid ◽  
2016 ◽  
Vol 26 (6) ◽  
pp. 785-793 ◽  
Author(s):  
Richard T. Kloos ◽  
Robert J. Monroe ◽  
S. Thomas Traweek ◽  
Richard B. Lanman ◽  
Giulia C. Kennedy
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Medullary Thyroid Cancer ◽  
Medullary Thyroid ◽  
Indeterminate Cytology

Calcitonin testing for detection of medullary thyroid cancer in patients with thyroid nodules

2012 ◽  
Author(s):  
Hans HG Verbeek ◽  
Jan Willem B de Groot ◽  
Wim J Sluiter ◽  
Anneke C Muller Kobold ◽  
John TM Plukker ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Medullary Thyroid Cancer ◽  
Medullary Thyroid

scholarly journals Diagnosis of Medullary Thyroid Cancer During COVID-19 Pandemic, the Benefit of Using a Standardized Protocol

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A889-A889
Author(s):  
Michael Mortensen ◽  
JiaXi Dong ◽  
Karyne Lima Vinales ◽  
Ricardo Rafael Correa
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Thyroid Nodules ◽  
Medullary Thyroid Cancer ◽  
Elevated Serum ◽  
Surrogate Marker ◽  
Calcitonin Level ◽  
Radiographic Appearance ◽  
Serum Calcitonin ◽  
Medullary Thyroid

Abstract Introduction: The reported prevalence of malignancy in thyroid nodules ranges from 4% to approximately 10%, with a small percentage (~2-8%) being medullary thyroid cancer (MTC). During the COVID-19 pandemic, elective thyroid FNA was temporarily halted at our institution. In response to this, our institution has devised a new protocol to aid in the detection of MTC, which includes serum calcitonin measurement as a surrogate marker for potential MTC. A severely elevated calcitonin (&gt;100 pg/mL) is considered for surgery even without FNA diagnosis. We present a case of MTC that was detected due to the adopting of this protocol during COVID-19 pandemic at the Phoenix VAMC. Case Presentation: 71 year old male with an incidentally noted 3.0 cm solid, hypoechoic nodule with internal calcification, TI-RADS category 5. TSH level was normal at 3.309 mIU/mL. The patient denied any personal or family history of thyroid cancer, MEN syndrome, radiation exposure, or compressive symptoms. Following established protocol published by our institution in clinical thyroidology we performed a serum calcitonin that came back elevated at 1515 pg/mL (normal &lt; 10 pg/mL). Given the marked elevation in serum calcitonin levels and highly suspicious radiographic appearance of the thyroid nodule, we strongly suspected medullary thyroid cancer and elected to send him directly for total thyroidectomy without performing FNA. The patient underwent total thyroidectomy with central neck dissection. Pathology showed a 3.2 cm medullary thyroid carcinoma without extrathyroidal extension or perineural invasion. Lymphovascular invasion was present. 6/10 central comparement lymph nodes were positive for metastatic disease. Postoperative calcitonin level was 2 pg/mL. Discussion: Our patient had markedly elevated serum calcitonin levels in addition to a high-risk ultrasonographic features, which was highly suspicious for MTC. Per our COVID-19 protocol, we measured the serum calcitonin level to screen for MTC and then referred him directly to surgery without FNA given the high suspicion for MTC. By using this protocol, we were able to diagnose and treat MTC expeditiously. The measurement of serum calcitonin is still controversial in the U.S, with the ATA remaining equivocal on this method. We believe that our case can serve as a practical example that validates our institution’s use of calcitonin screening of thyroid nodules in diagnosing MTC during the COVID-19 pandemic.

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