Calcitonin screening in patients with thyroid nodules

Schneider, Carsten; Kobe, Carsten; Schmidt, Mathias; Kahraman, Deniz; Malchau, Gebhart; Faust, Michael; Schicha, H.; Dietlein, Markus

doi:10.3413/nukmed-0494-12-04

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…The frequency of MTC cases detected by means of routine Ctn measurement in patients with nodular thyroid glands of at least 0.12% (max. 0.14%, including the statistically expected 2 MTC in the group of unclarified cases) corresponds well with previous studies carried out in Germany: Rink et al [27] reported 28/21,928 (0.13%), Herrmann et al [28] reported 2/1007 (0.2%), and Schneider et al [29] reported 10/11,270 (0.09%).…”

Section: Spectrum Of Screening Ctn Values and Mtc Prevalencesupporting

confidence: 91%

“…It is one of the largest single-center studies on this topic worldwide that is evaluating long-term courses. Three previous German studies on routine Ctn measurement used sex-independent cut-off values, as have most international studies [17]: Rink et al [27] and Herrmann et al [28] used a Ctn threshold of 10 pg/mL and Schneider et al [29] used a Ctn threshold of 13 pg/mL. Values of 1 1 2 to 2 times higher male than female reference ranges and threshold values are now generally accepted in both adults and children [30][31][32][33] and reflect the fact that the density of thyroid C cells is about twice as high in male subjects compared to female subjects [18,30].…”

Section: Discussionmentioning

confidence: 99%

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Update on Calcitonin Screening for Medullary Thyroid Carcinoma and the Results of a Retrospective Analysis of 12,984 Patients with Thyroid Nodules

Broecker-Preuß

Simon²,

Fries

et al. 2023

Cancers

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Background: We provide an update on calcitonin (Ctn) screening for the early detection of medullary thyroid carcinoma (MTC) and present the results of a large single-center analysis evaluating sex-specific cut-off-levels and long-term courses. Methods: A total of 12,984 consecutive adult patients (20.1% male and 79.9% female) with thyroid nodules who had undergone routine Ctn measurement were retrospectively analyzed. Patients with confirmed suspicious Ctn values were referred for surgery. Results: Ctn measurements were elevated in 207 (1.6%) patients, with values below twice the sex-specific reference limit in 82% of these cases. Further clarification was possible in 124/207 cases, of which MTC could be ruled out in 108 cases. Histopathological assessment confirmed MTC in 16/12,984 patients. Conclusions: Our extrapolated MTC prevalence of 0.14% is significantly lower than that described in early international screening studies. The stimulation test can usually be dispensable when using a decision-making concept based on sex-specific basal Ctn cut-off values. Ctn screening is recommended even in patients with very small thyroid nodules. High quality standards in pre-analytics, laboratory measurements, and the interpretation of data must be ensured, as well as close interdisciplinary cooperation between medical disciplines.

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Section: Spectrum Of Screening Ctn Values and Mtc Prevalencesupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Update on Calcitonin Screening for Medullary Thyroid Carcinoma and the Results of a Retrospective Analysis of 12,984 Patients with Thyroid Nodules

Broecker-Preuß

Simon²,

Fries

et al. 2023

Cancers

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“…A 10-year survival rate of 97.7% has been reported [31]. Because of the high sensitivity and specificity of serum hCT measurement by immunoassay technology using two monoclonal antibodies routine hCT measurement has been suggested for assesment of patients with thyroid nodular disease by major authorities in Europe [2,20,32,33] and the United States [34,35]. Yet it is not rountinely performed in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, Hashimoto’s thyroiditis, nodular goitre and the use of proton pump inhibitors (PPIs) have been reported to influence basal serum hCT concentrations [3,15]–[20]. If, for example, patients are intolerable to pentagastrin and cannot undergo a pentagastrin stimulation test for an evaluation of increased serum hCT levels, omeprazole can be used instead to induce an increase in serum hCT concentrations [16].…”

Section: Introductionmentioning

confidence: 99%

“…levels that are no more than 10 times higher than normal, are difficult to evaluate, especially in the absence of clinical evidence and the presence of potential influencing factors that have been described in the literature. For this reason, the diagnostic value of mildly or moderately increased hCT levels is currently being discussed in the literature [20]. A concrete evaluation of these levels is required.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of factors potentially influencing calcitonin levels in the screening and follow-up for medullary thyroid carcinoma: a cautionary note

et al. 2013

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BackgroundThe malignant transformation of thyroid C cells is associated with an increase in human calcitonin (hCT), which can thus be helpful in the early diagnosis of medullary thyroid carcinoma (MTC). For this reason, hCT levels should be determined in all patients with nodular goitre. Hashimoto’s thyroiditis, nodular goitre and proton pump inhibitor (PPI) therapy are factors reported to influence basal serum hCT concentrations. The diagnostic role of mildly to moderately increased hCT levels is thus a matter of debate. In this study, we attempt to clarify the role of the aforementioned factors.MethodsFrom 2008 to 2009, we collected data from 493 patients who were divided into five groups. We assessed whether there were significant differences in hCT levels between patients with Hashimoto’s thyroiditis, patients with nodular goitre, patients with PPI therapy, and healthy control subjects. In addition, we investigated whether a delayed analysis of blood samples has an effect on serum hCT concentrations.ResultsImmunoradiometric assays (Calcitonin IRMA magnum, MEDIPAN) revealed that the time of analysis did not play a role when low levels were measured. Delayed analysis, however, carried the risk of false low results when serum hCT concentrations were elevated. Men had significantly higher serum hCT levels than women. The serum hCT concentrations of patients with Hashimoto’s thyroiditis and nodular goitre were not significantly different from those of control subjects. Likewise, PPI therapy did not lead to a significant increase in serum hCT concentrations regardless of the presence or absence of nodular goitre.ConclusionsIncreases in serum hCT levels are not necessarily attributable to Hashimoto’s thyroiditis, nodular goitre or the regular use of PPIs and always require further diagnostic attention.

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

Verbeek

Groot

Sluiter

et al. 2020

Cochrane Database of Systematic Reviews

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Calcitonin screening in patients with thyroid nodules

Abstract: 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.

Cited by 9 publications

References 27 publications

Update on Calcitonin Screening for Medullary Thyroid Carcinoma and the Results of a Retrospective Analysis of 12,984 Patients with Thyroid Nodules

Update on Calcitonin Screening for Medullary Thyroid Carcinoma and the Results of a Retrospective Analysis of 12,984 Patients with Thyroid Nodules

Investigation of factors potentially influencing calcitonin levels in the screening and follow-up for medullary thyroid carcinoma: a cautionary note

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

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