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

Abstract

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.

Diagnostic, Theranostic and Prognostic Value of Thyroglobulin in Thyroid Cancer

“…For clarification of the malignant potential of thyroid nodules, Tg measurement is decidedly not recommended in the guidelines of international thyroid societies, such as the British Thyroid Association [63] or the American Thyroid Association [2]. The main argument for this is that an increased Tg release is found not only in thyroid follicular cell-derived carcinomas (DTC) but also in various benign thyroid processes (e.g., thyroid enlargement, benign thyroid nodules, hyperthyroidism, thyroiditis), and it is therefore very unspecific [64], in contrast to calcitonin, which has a relatively high specificity with regard to "screening" for medullary thyroid carcinoma (MTC) [65]. For example, in a case report, an extreme Tg elevation up to 22,000 ng/mL was recorded in a patient with Hashimoto's thyroiditis [66].…”

Management of Thyroid Nodules

“…In addition, MTC is a rare form and its incidence in thyroid nodules is 0.14-0.4%. [33,34] Routine measurement of calcitonin in the evaluation of thyroid nodules is controversial. [35] Serum calcitonin measurement is recommended in selected patients with nodules who have a family history and clinical suspicion of familial MTC.…”