Ann Surg Treat Res.  2017 Apr;92(4):173-178. 10.4174/astr.2017.92.4.173.

Routine calcitonin measurement in nodular thyroid disease management: is it worthwhile?

• Turk Y
• Makay O
• Ozdemir M
• Ertunc G
• Demir B
• Icoz G
• Akyildiz M
• Yilmaz M

• KMID: 2374681
• DOI: http://doi.org/10.4174/astr.2017.92.4.173

Abstract

PURPOSE
To evaluate the diagnostic accuracy of routine calcitonin measurement in patients with nodular thyroid disease.
METHODS
Consecutive patients with nodular thyroid disease (n = 640) were studied. Serum calcitonin levels were measured under basal conditions, and when basal values were between 10-100 pg/mL, testing was repeated after pentagastrin (PG) stimulation. Patients with previously diagnosed or familial medullary thyroid cancer (MTC) were excluded. Patients were operated on when basal or stimulated calcitonin >100 pg/mL or when other surgical indications were present.
RESULTS
Four cases of MTC were identified. MTC was diagnosed in 75% of patients with basal calcitonin >100 pg/mL. One out of 11 patients with basal calcitonin between 10-100 pg/mL was diagnosed with MTC. PG stimulation resulted in elevation in 4 cases, where 1 case was diagnosed with MTC. Positive predictive value for basal calcitonin levels in the preoperative diagnosis of MTC was 5% for values between 10-100 pg/mL and 100% for values >100 pg/mL. Possible reasons for false positivity were papillary thyroid cancer in 17%, renal insufficiency in 8.3%, Hashimoto thyroiditis in 17% and β-blocker use in 33%. Positive predictive value for the PG test (>100 pg/mL) was 25% in the entire series. The cost of adding calcitonin measurement (±PG stimulation) to the preoperative work-up, resulted in €912.68 per MTC patient to detect the disease.
CONCLUSION
Basal calcitonin measurement together with PG stimulation in cases of basal calcitonin >10 pg/mL detects MTC in 0.62% of patients with nodular thyroid disease.

Keyword

Thyroid nodule; Calcitonin; Cytology

MeSH Terms

Calcitonin*
Diagnosis
Hashimoto Disease
Humans
Pentagastrin
Renal Insufficiency
Thyroid Diseases*
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule
Calcitonin
Pentagastrin

Figure

• 

  Fig. 1 Medullary thyroid cancer located in the inferior zone of the right thyroid lobe (arrow).

• 

  Fig. 2 Metastatic central lymph node of a medullary thyroid cancer case (arrow).

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