Routine Measurement of Plasma Calcitonin in Nodular Thyroid Diseases

Abstract

In a prospective study, plasma concentrations of human calcitonin (hCT) were determined in 1062 consecutive patients with thyroid nodular disease. Basal plasma hCT was above the normal range (Ͼ6 pg/mL) in 55 patients and was elevated up to more than 100 pg/mL (range, 127-5459) in 3 of these 55 patients. A pentagastrin-induced rise in hCT up to more than 100 pg/mL was observed in only 1 of 38 patients with a basal concentration of hCT between 5-10 pg/mL, but was found in 10 of 31 patients with basal hCT ranging from 10 -100 pg/mL. Histologically, 7 of the 14 patients with either basal or stimulated plasma concentrations of hCT above 100 pg/mL presented C cell hyperplasia, which in one case showed histological transition into a small (diameter, 3 mm) medullary thyroid carcinoma (MTC). Including this patient, MTC was found in 6 of the 12 patients. We conclude that the routine determination of hCT in all patients with thyroid nodular disease should be supplemented by pentagastrinstimulation when the basal hCT concentration exceeds 10 pg/mL. Patients with basal and/or stimulated plasma CT concentrations of more than 100 pg/mL should be operated on because they run a substantial risk to suffer either MTC or C cell hyperplasia, a potentially precancerous condition. This will increase the chance of a timely diagnosis of MTC and provide the chance of curative surgery. (J Clin Endocrinol Metab 82: 1589 -1593, 1997

Reference range of serum calcitonin levels in humans: influence of calcitonin assays, sex, age, and cigarette smoking

“…It occurs in 5-10% of thyroid tumors (1) and has a prevalence of between 0.3 and 1.37% in nodular thyroid disease (2)(3)(4)(5)(6)(7)(8)(9). Calcitonin (C T ) is a marker for both initial diagnosis and monitoring of patients with residual or recurrent MTC (10,11).…”

“…Serum C T assays are indicated in nodular thyroid patients if there is a family history of MTC, multiple endocrine neoplasia type 2, or non-defined thyroid cancer (1). In Europe, several researchers have recommended the systematic use of serum C T assays in all nodular thyroid patients, in order to identify sporadic MTC as early as possible (2)(3)(4)(5)(7)(8)(9), optimize surgical treatment (12), and obtain better survival (13).…”

“…The prevalence of hypercalcitoninemia not due to MTC varies from 0.3 to 4.5% (2)(3)(4)(5)(6)(7)(8)(9). The assay's high cost and lack of specificity (25) has dissuaded health authorities in the USA from adopting systematic testing (1,26).…”

Nodular disease and parafollicular C-cell distribution: results from a prospective and retrospective clinico-pathological study on the thyroid isthmus

“…Actually, two diagnostic tools are available for the evaluation of patients with NTD, including those with MTC: FNAC and measurement of human C t concentrations. Previous European studies recruiting large series of patients with NTD (6)(7)(8)(9)(10)(11)(12) demonstrated that it is possible to diagnose MTC earlier with C t screening than FNAC, particularly in patients with nodules smaller than 10 mm (microMTCs). Hence, the ETA has recommended C t screening in all subjects with NTD (13).…”

“…Several studies (6)(7)(8)(9)(10)(11)(12) on sporadic MTC have demonstrated that the earlier the diagnosis the better the prognosis of MTC. C t has been shown to represent a sensitive marker for MTC, leading to the early diagnosis of the neoplasm even when fine needle aspiration cytology (FNAC) discloses benign features (as occurs in nodules smaller than 10 mm).…”