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Horm Metab Res 2021; 53(12): 779-786
DOI: 10.1055/a-1661-4420
Endocrine Care

Thresholds of Basal- and Calcium-Stimulated Calcitonin for Diagnosis of Thyroid Malignancy

Mara Băetu 
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,
Cristina Alexandra Olariu
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Cristina Stancu
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Andra Caragheorgheopol
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,
Dumitru Ioachim
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Gabriel Moldoveanu
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Cristina Corneci
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
,
Corin Badiu
1   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Abstract

Since medullary thyroid carcinoma is an aggressive cancer, it is important to have an early detection based on stimulated calcitonin (CT), especially when basal-CT is slightly elevated. The objective of this work was to set specific thresholds for basal-CT- and calcium-stimulated calcitonin for prediction of thyroid malignancy in female population. The study included 2 groups: group A-women with elevated basal-CT (>9.82 pg/ml) and group B-women with normal basal-CT (control group). After calcium stimulation test precise protocol, histopathological reports of those that required surgery were correlated with both basal and stimulated calcitonin. The best basal and stimulated calcitonin cut-offs for distinguishing female patients with medullary thyroid carcinoma or C-Cell-hyperplasia from other pathologies or normal cases were: 12.9 pg/ml, respectively 285.25 pg/ml. For basal-CT above 30 pg/ml, malignancy was diagnosed in 9/9 patients (100%): 9 MTC. For stimulated calcitonin above 300 pg/ml, malignancy was diagnosed in 17/21 patients (80.95%): 12 MTC and 5 papillary thyroid carcinomas. The smallest nodule that proved to be medullary thyroid carcinoma had only 0.56/0.34/0.44 cm on ultrasound, with no other sonographic suspicious criteria. In conclusion, we have identified in Romanian female population basal and stimulated calcitonin thresholds to discriminate medullary thyroid carcinoma or C-Cell-hyperplasia from other cases. We recommend thyroid surgery in all women with stimulated calcitonin above 285 pg/ml. Further studies on larger groups are necessary to establish and confirm male and female cut-offs for early diagnosis of medullary thyroid carcinoma, and interestingly, maybe for macro-papillary thyroid carcinomas alike. The calcium administration has minimum side-effects, but continuous cardiac monitoring is required.

Key words

calcitonin - stimulation test - thresholds - cut-off - medullary thyroid carcinoma


Publication History

Received: 16 July 2021

Accepted after revision: 27 September 2021

Article published online:
22 October 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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