Diagnóstico laboratorial do carcinoma medular de tiróide: calcitonina basal e testes de estímulo

Hauache, Omar M.; Vieira, José Gilberto H.; Maciel, Rui M. B.

doi:10.1590/s0004-27302003000500005

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…The routine measurement of calcitonin to screen for MTC in patients with nodular thyroid disease is still controversial. Several researchers recommend it, 9 , 32 – 35 including the European consensus group. 36 However, the American Thyroid Association 37 has raised concerns about some possible limitations to this procedure.…”

Section: Introductionmentioning

confidence: 99%

Hypercalcitoninemia is not Pathognomonic of Medullary Thyroid Carcinoma

Toledo

Lourenço

Santos

et al. 2009

Clinics

127

120

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Hypercalcitoninemia has frequently been reported as a marker for medullary thyroid carcinoma. Currently, calcitonin measurements are mostly useful in the evaluation of tumor size and progression, and as an index of biochemical improvement of medullary thyroid carcinomas. Although measurement of calcitonin is a highly sensitive method for the detection of medullary thyroid carcinoma, it presents a low specificity for this tumor. Several physiologic and pathologic conditions other than medullary thyroid carcinoma have been associated with increased levels of calcitonin. Several cases of thyroid nodules associated with increased values of calcitonin are not medullary thyroid carcinomas, but rather are related to other conditions, such as hypercalcemias, hypergastrinemias, neuroendocrine tumors, renal insufficiency, papillary and follicular thyroid carcinomas, and goiter. Furthermore, prolonged treatment with omeprazole (> 2–4 months), beta-blockers, glucocorticoids and potential secretagogues, have been associated with hypercalcitoninemia. An association between calcitonin levels and chronic auto-immune thyroiditis remains controversial. Patients with calcitonin levels >100 pg/mL have a high risk for medullary thyroid carcinoma (~90%–100%), whereas patients with values from 10 to 100 pg/mL (normal values: <8.5 pg/mL for men, < 5.0 pg/mL for women; immunochemiluminometric assay) have a <25% risk for medullary thyroid carcinoma.In multiple endocrine neoplasia type 2 (MEN2), RET mutation analysis is the gold-standard for the recommendation of total preventive thyroidectomy to relatives at risk of harboring a germline RET mutation (50%). False-positive calcitonin results within MEN2 families have led to incorrect indications of preventive total thyroidectomy to RET mutation negative relatives. In this review, we focus on the differential diagnosis of hypercalcitoninemia, underlining its importance for the avoidance of misdiagnosis of medullary thyroid carcinoma and consequent incorrect recommendation for thyroid surgery.

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Section: Introductionmentioning

confidence: 99%

Hypercalcitoninemia is not Pathognomonic of Medullary Thyroid Carcinoma

Toledo

Lourenço

Santos

et al. 2009

Clinics

127

120

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“… 34 Others have also recommended this procedure. 37 Up to 1.4% of previously unsuspected MTC cases have been reported in unselected sequential cases presenting with thyroid nodules. 23 Furthermore, the cost benefits of routine calcitonin measurements and of therapeutic procedures have recently been evaluated.…”

Section: Discussionmentioning

confidence: 99%

Sporadic Medullary Thyroid Carcinoma: Clinical Data From A University Hospital

Correia-Deur

Toledo

Imazawa

et al. 2009

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INTRODUCTION:Medullary thyroid carcinoma may occur in a sporadic (s-medullary thyroid carcinoma, 75%) or in a multiple endocrine neoplasia type 2 form (MEN2, 25%). These clinical forms differ in many ways, as s-medullary thyroid carcinoma cases are RET-negative in the germline and are typically diagnosed later than medullary thyroid carcinoma in MEN2 patients. In this study, a set of cases with s-medullary thyroid carcinoma are documented and explored. PURPOSE: To document the phenotypes observed in s-medullary thyroid carcinoma cases from a university group and to attempt to improve earlier diagnosis of s-medullary thyroid carcinoma. Some procedures for diagnostics are also recommended. METHOD: Patients (n=26) with apparent s-medullary thyroid carcinoma were studied. Their clinical data were reviewed and peripheral blood was collected and screened for RET germline mutations. RESULTS:The average age at diagnosis was 43.9 years (± 10.82 SD) and did not differ between males and females. Calcitonin levels were increased in all cases. Three patients presented values that were 100-fold greater than the normal upper limit. Most (61.54%) had values that were 20-fold below this limit. Carcinoembryonic antigen levels were high in 70.6% of cases. There was no significant association between age at diagnosis, basal calcitonin levels or time of disease onset with thyroid tumor size (0.6-15 cm). Routine thyroid cytology yielded disappointing diagnostic accuracy (46.7%) in this set of cases. After total thyroidectomy associated with extensive cervical lymph node resection, calcitonin values remained lower than 5 pg/mL for at least 12 months in eight of the cases (30.8%). Immunocyto-and histochemistry for calcitonin were positive in all analyzed cases. None of the 26 cases presented germline mutations in the classical hotspots of the RET proto-oncogene. CONCLUSION: Our cases were identified late. The basal calcitonin measurements and immunostaining for calcitonin were highly useful for diagnosing s-medullary thyroid carcinoma. The rate of complete patient recovery was low, and none of the parameters analyzed were useful predictors of the thyroid tumor size. Our findings support previous recommendations for routine serum calcitonin evaluation and immunostaining analysis involving single thyroid nodules.

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“…To perform the pentagastrin test, patients fasted for 8 h, and blood samples were drawn before and 2, 5, 10 and 15 min after an intravenous bolus of 0.5 g/kg pentagastrin (Pentagastrin™; Cambridge Laboratories Ltd, Newcastle, UK) [16]. All 225 samples derived from these tests were centrifuged, and serum aliquots were stored at -20°C until sCT measurements.…”

Section: Methodsmentioning

confidence: 99%

Development and Application of a Novel Sensitive Immunometric Assay for Calcitonin in a Large Cohort of Patients with Medullary and Differentiated Thyroid Cancer, Thyroid Nodules, and Autoimmune Thyroid Diseases

et al. 2014

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Background: Serum calcitonin (sCT) is a useful biomarker for medullary thyroid cancer (MTC). Consensus has not been reached concerning sCT measurements in the evaluation of nodular thyroid disease (NTD). Objective and Methods: We developed a new immunofluorometric assay for sCT and have validated it in samples from 794 patients [203 with MTC, 205 with autoimmune thyroid disease (ATD), 248 with NTD, 80 with differentiated thyroid cancer (DTC) ‘free of disease', 58 with chronic renal failure (CRF)] and 178 normal individuals, including samples after pentagastrin tests and samples from the washout of 92 FNA procedures in patients with NTD or MTC. We also compared some samples from patients with low or high calcitonin levels using both this assay and the Nichols Institute Diagnostics (NID) assay. Results: The assay's analytical sensitivity was 1.0 pg/ml. Considering MTC patients prior to surgery, the cut-off values for the 95% reference range were 11.1 pg/ml for males and 5.5 pg/ml for females and employing the ROC curve were 18.4 pg/ml for males and 7.8 pg/ml for females. sCT in patients with MTC was strongly correlated with disease status. Patients with NTD and ATD did not present false-positive results. sCT measurements were significantly correlated with age (excluding MTC and CRF). The NID test had a strong correlation with our assay. A hook effect was observed only with concentrations >200,000 pg/ml. Conclusions: We developed a novel sCT assay and validated it in healthy subjects, as well as in a large cohort of patients with MTC, NTD, ATD, DTC, and CRF.

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Diagnóstico laboratorial do carcinoma medular de tiróide: calcitonina basal e testes de estímulo

Cited by 8 publications

References 26 publications

Hypercalcitoninemia is not Pathognomonic of Medullary Thyroid Carcinoma

Hypercalcitoninemia is not Pathognomonic of Medullary Thyroid Carcinoma

Sporadic Medullary Thyroid Carcinoma: Clinical Data From A University Hospital

Development and Application of a Novel Sensitive Immunometric Assay for Calcitonin in a Large Cohort of Patients with Medullary and Differentiated Thyroid Cancer, Thyroid Nodules, and Autoimmune Thyroid Diseases

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