Calcitonin Screening in Nodular Thyroid Disease: Is There a Definitive Answer?

Abstract

Introduction: Calcitonin (Ctn) is a hormone secreted by thyroid “C” cells and is considered an excellent marker for medullary thyroid carcinoma (MTC). However, the use of Ctn to screen patients with nodular thyroid disease (NTD) remains controversial. Objective: The aim of this work was to define the frequency of hypercalcitoninemia among NTD patients followed at a tertiary referral hospital. Methods: A retrospective analysis was made of basal Ctn measurements and corresponding patients’ records between January 2011 and December 2015. Hypercalcitoninemia was defined as > 10 pg/mL. Depending on the Ctn value, three groups were considered: G1, ≤10 pg/mL; G2, 10–100 pg/mL; G3, ≥100 pg/mL. Results: Ctn was requested in an NTD context for 1,504 patients, 69 of whom had hypercalcitoninemia. Of these, 20 underwent surgery (G2, 11; G3, 9), and a histological diagnosis of MTC was established in 12 (G2, 3/27%; G3, 9/100%). Surgery was chosen based solely on Ctn levels in 7 cases, since only 5 had a positive cytology. Conclusions: Hypercalcitoninemia was found in 4.6% of NTD patients. Ctn levels ≥100 pg/mL were associated with a greater CMT risk than values between 10 and 100 pg/mL, reinforcing results from other groups. The need for an adequate interpretation of results as well as an appropriate selection of patients to surgery stresses the importance of endocrinologists requesting and interpreting results.

Diagnostic accuracy of routine calcitonin measurement for the detection of medullary thyroid carcinoma in the management of patients with nodular thyroid disease: a meta-analysis

“…None of the trials was a case-control study. The detailed characteristics of the included studies are given in Table 1 ( 15 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ). According to the QUADAS-2 tool ( 22 , 23 ), the methodological quality of the included trials was acceptable ( Fig.…”

“…In all other studies, patients with ultrasonographically confirmed nodules irrespective of size were included. Only the retrospective analysis by Silvestre et al ( 49 ) does not specifically describe that the nodules were objectified by ultrasonography (’the exclusion criteria were absence of clinical information, and no evidence of NTD or individuals with a familial history of MTC’). In the study by Giovanella et al ( 47 ) patients who only had autonomously functioning thyroid nodules where not included.…”

Calcitonin: current concepts and differential diagnosis

“… 43 , 56 – 59 Numerous studies have tried to determine the exact role of routine CT measurement in cases of thyroid nodular disease. 56 – 61 All studies suggest that screening of thyroid nodules with serum CT measurement allows the diagnosis and treatment of MTC at an earlier stage, resulting in a better outcome compared with MTC not detected by serum CT measurement. One of the reasons for this finding is that increasing the preoperative diagnostic accuracy of MTC prompts the surgeon to perform a more radical and possibly curative treatment.…”

The Role of Calcitonin in the Preoperative Stage as the Predictor of Medullary Thyroid Cancer Metastases

“…We considered the possibility of using preoperative calcitonin levels as a marker of possible metastases. Current recommendations of the American Thyroid Association (ATA) advise to measure the calcitonin level in the blood serum in cases where the cytological conclusion in patients diagnosed (or suspected) of thyroid cancer and the calcitonin level may be a predictor of the disease (Wells, et al, 2015;Silvestre, et al, 2019).…”