Download PDF
Horm Metab Res 2016; 48(06): 372-276
DOI: 10.1055/s-0042-107246
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Usefulness of Serum Calcitonin in Patients Without a Suspicious History of Medullary Thyroid Carcinoma and with Thyroid Nodules Without an Indication for Fine-Needle Aspiration or with Benign Cytology

P. W. Rosario
1   Santa Casa de Belo Horizonte, Minas Gerais, Brazil
,
M. R. Calsolari
1   Santa Casa de Belo Horizonte, Minas Gerais, Brazil
› Author Affiliations
Further Information

Publication History

received 16 February 2016

accepted 19 April 2016

Publication Date:
20 May 2016 (online)

Also available at
   Permissions and Reprints

Abstract

This study evaluated the usefulness of serum calcitonin (Ctn) in subjects without a suspicious history of medullary thyroid carcinoma (MTC) and with nodular thyroid disease without an indication for fine-needle aspiration (FNA) or with benign cytology. This was a prospective study that evaluated 421 patients with nodular disease without an indication for FNA and 602 patients with benign cytology. Patients with basal Ctn>10 pg/ml were submitted to calcium stimulation testing. Patients with stimulated Ctn>100 pg/ml were submitted to total thyroidectomy. Basal Ctn was<10 pg/ml in 1001 patients (97.8%). Among patients with basal Ctn>10 pg/ml, 16/22 exhibited stimulated Ctn>100 pg/ml. Two of these 16 patients had MTC. The 2 patients with MTC had undetectable basal Ctn 6 months after surgery. Using a cut-off of 30 pg/ml in women and 60 pg/ml in men for basal Ctn, the 2 cases of MTC of our series would have been identified and there would have been no false-positive case. It should be noted that 14/16 patients with stimulated Ctn>100 pg/ml were false-positive cases. Although uncommon, even subjects without a suspicious history and with nodular thyroid disease without an indication for FNA or with benign cytology can have MTC. The measurement of Ctn permits the diagnosis of these cases. Our results favor the hypothesis that basal Ctn could be superior to stimulated Ctn.

Key words

serum calcitonin - thyroid nodule - medullary thyroid carcinoma
 

  • References

  • 1 Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787-803
    CrossrefPubMedGoogle Scholar
  • 2 Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract 2010; 16: 1-43
    CrossrefPubMedGoogle Scholar
  • 3 Wells Jr AS, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee NY, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal S, Santoro M, Schlumberger M, Shah MH, Waguespack SG. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma The American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Thyroid 2015; 25: 567-610
    CrossrefPubMedGoogle Scholar
  • 4 Elisei R, Bottici V, Luchetti F, Di Coscio G, Romei C, Grasso L, Miccoli P, Iacconi P, Basolo F, Pinchera A, Pacini F. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 1994; 89: 163-168
    PubMedGoogle Scholar
  • 5 Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard BaG, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. British Thyroid Association . Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 (Suppl. 01) 1-122
    PubMedGoogle Scholar
  • 6 Haugen BR, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward D, Tuttle RM, Wartofsky L. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1-133
    CrossrefPubMedGoogle Scholar
  • 7 Rosario PW, Penna GC, Brandão K, Souza BÉ. Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma. Arq Bras Endocrinol Metabol 2013; 57: 312-316
    CrossrefPubMedGoogle Scholar
  • 8 Rosario PW, Calsolari MR. Influence of chronic autoimmune thyroiditis and papillary thyroid cancer on serum calcitonin levels. Thyroid 2013; 23: 671-674
    CrossrefPubMedGoogle Scholar
  • 9 Beressi N, Campos JM, Beressi JP, Franc B, Niccoli-Sire P, Conte-Devolx B, Murat A, Caron P, Baldet L, Kraimps JL, Cohen R, Bigorgne JC, Chabre O, Lecomte P, Modigliani E. Sporadic medullary microcarcinoma of the thyroid: a retrospective analysis of eighty cases. Thyroid 1998; 8: 1039-1044
    CrossrefPubMedGoogle Scholar
  • 10 Guyétant S, Dupre F, Bigorgne JC, Franc B, Dutrieux-Berger N, Lecomte-Houcke M, Patey M, Caillou B, Viennet G, Guerin O, Saint-Andre JP. Medullary thyroid microcarcinoma: a clinicopathologic retrospective study of 38 patients with no prior familial disease. Hum Pathol 1999; 30: 957-963
    CrossrefPubMedGoogle Scholar
  • 11 Machens A, Dralle H. Biological relevance of medullary thyroid microcarcinoma. J Clin Endocrinol Metab 2012; 97: 1547-1553
    CrossrefPubMedGoogle Scholar
  • 12 Kazaure HS, Roman SA, Sosa JÁ. Medullary thyroid microcarcinoma: a population-level analysis of 310 patients. Cancer 2012; 118: 620-627
    CrossrefPubMedGoogle Scholar
  • 13 Saltiki K, Rentziou G, Stamatelopoulos K, Georgiopoulos G, Stavrianos C, Lanbrinoudaki E, Alevizaki M. Small medullary thyroid carcinoma (MTC): postoperative calcitonin rather than tumour size predict disease persistence and progression. Eur J Endocrinol 2014; 171: 117-126
    CrossrefPubMedGoogle Scholar
  • 14 Lee S, Shin JH, Han BK, Ko EY. Medullary thyroid carcinoma: comparison with papillary thyroid carcinoma and application of current sonographic criteria. AJR Am J Roentgenol 2010; 194: 1090-1094
    CrossrefPubMedGoogle Scholar
  • 15 Choi N, Moon WJ, Lee JH, Baek JH, Kim DW, Park SW. Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol 2011; 52: 312-316
    CrossrefPubMedGoogle Scholar
  • 16 Trimboli P, Cremonini N, Ceriani L, Saggiorato E, Guidobaldi L, Romanelli F, Ventura C, Laurenti O, Messuti I, Solaroli E, Madaio R, Bongiovanni M, Orlandi F, Crescenzi A, Valabrega S, Giovanella L. Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study. Clin Endocrinol (Oxf) 2014; 80: 135-140
    CrossrefPubMedGoogle Scholar
  • 17 Trimboli P, Treglia G, Guidobaldi L, Romanelli F, Nigri G, Valabrega S, Sadeghi R, Crescenzi A, Faquin WC, Bongiovanni M, Giovanella L. Detection rate of FNA cytology in medullary thyroid carcinoma: a meta-analysis. Clin Endocrinol (Oxf) 2015; 82: 280-285
    CrossrefPubMedGoogle Scholar
  • 18 Niccoli P, Wion-Barbot N, Caron P, Henry JF, De Micco E, Saint Andre JP, Bigorgne JC, Modigliani E, Conte-Devolx B. Interest of routine measurement of serum calcitonin: study in a large series of thyroidectomized patients. J Clin Endocrinol Metab 1997; 82: 338-341
    CrossrefPubMedGoogle Scholar
  • 19 Henry JF, Denizot A, Puccini M, Gramatica L, Kvachenyuk A, Conte Devolx B, De Micco C. Latent subclinical medullary thyroid carcinoma: diagnosis and treatment. World J Surg 1998; 22: 752-756
    CrossrefPubMedGoogle Scholar
  • 20 Bugalho MJ, Santos JR, Sobrinho L. Preoperative diagnosis of medullary thyroid carcinoma: fine needle aspiration cytology as compared with serum calcitonin measurement. J Surg Oncol 2005; 91: 56-60
    CrossrefPubMedGoogle Scholar
  • 21 Essig GF, Porter K, Schneider D, Debora A, Lindsey SC, Busonero G, Fineberg D, Fruci B, Boelaert K, Smit JW, Meijer JA, Duntas L, Sharma N, Costante G, Filetti S, Sippel RS, Biondi B, Topliss DJ, Pacini F, Maciel RM, Walz PC, Kloos RT. Fine needle aspiration and medullary thyroid carcinoma: the risk of inadequate preoperative evaluation and initial surgery when relying upon FNAB cytology alone. Endocr Pract 2013; 19: 920-927
    CrossrefPubMedGoogle Scholar
  • 22 Costante G, Meringolo D, Durante C, Bianchi D, Nocera M, Tumino S, Crocetti U, Attard M, Maranghi M, Torlontano M, Filetti S. Predictive value of serum calcitonin levels for preoperative diagnosis of medullary thyroid carcinoma in a cohort of 5817 consecutive patients with thyroid nodules. J Clin Endocrinol Metab 2007; 92: 450-455
    CrossrefPubMedGoogle Scholar
  • 23 Rink T, Truong PN, Schroth HJ, Diener J, Zimny M, Grunwald F. Calculation and validation of a plasma calcitonin limit for early detection of medullary thyroid carcinoma in nodular thyroid disease. Thyroid 2009; 19: 327-332
    CrossrefPubMedGoogle Scholar
  • 24 Ahmed SR, Ball DW. Clinical review: Incidentally discovered medullary thyroid cancer: diagnostic strategies and treatment. J Clin Endocrinol Metab 2011; 96: 1237-1245
    CrossrefPubMedGoogle Scholar
  • 25 Scheuba C, Kaserer K, Moritz A, Drosten R, Vierhapper H, Bieglmayer C, Haas OA, Niederle B. Sporadic hypercalcitoninemia: clinical and therapeutic consequences. Endocr Relat Cancer 2009; 16: 243-253
    PubMedGoogle Scholar
  • 26 Doyle P, Duren C, Nerlich K, Verburg FA, Grelle I, Jahn H, Fassnacht M, Mäder U, Reiners C, Luster M. Potency and tolerance of calcitonin stimulation with high-dose calcium vs. pentagastrin in normal adults. J Clin Endocrinol Metab 2009; 94: 2970-2974
    CrossrefPubMedGoogle Scholar
  • 27 Colombo C, Verga U, Mian C, Ferrero S, Perrino M, Vicentini L, Dazzi D, Opocher G, Pelizzo MR, Beck-Peccoz P, Fugazzola L. Comparison of calcium and pentagastrin tests for the diagnosis and follow-up of medullary thyroid cancer. J Clin Endocrinol Metab 2012; 97: 905-913
    CrossrefPubMedGoogle Scholar
  • 28 Lorenz K, Elwerr M, Machens A, Abuazab M, Holzhausen HJ, Dralle H. Hypercalcitoninemia in thyroid conditions other than medullary thyroid carcinoma: a comparative analysis of calcium and pentagastrin stimulation of serum calcitonin. Langenbecks Arch Surg 2013; 398: 403-409
    CrossrefPubMedGoogle Scholar
  • 29 Chambon G, Alovisetti C, Idoux-Louche C, Reynaud C, Rodier M, Guedj AM, Chapuis H, Lallemant JG, Lallemant B. The use of preoperative routine measurement of basal serum thyrocalcitonin in candidates for thyroidectomy due to nodular thyroid disordes: results from 2733 consecutive patients. J Clin Endocrinol Metab 2011; 96: 75-81
    CrossrefPubMedGoogle Scholar
  • 30 Mian C, Perrino M, Colombo C, Cavedon E, Pennelli G, Ferrero S, De Leo S, Sarais C, Cacciatore C, Irene Manfredi G, Verga U, Iacobone M, De Pasquale L, Pelizzo MR, Vicentini L, Persani L, Fugazzola L. Refining calcium test for the diagnosis of medullary thyroid cancer: cut-offs, procedures and safety. J Clin Endocrinol Metab 2014; 99: 1656-1664
    CrossrefPubMedGoogle Scholar
  • 31 Trimboli P, Guidobaldi L, Bongiovanni M, Crescenzi A, Alevizaki M, Giovanella L. Use of fine-needle aspirate calcitonin to detect medullary thyroid carcinoma: A systematic review. Diagn Cytopathol 2016; 44: 45-51
    CrossrefPubMedGoogle Scholar
  • 32 Cheung K, Roman SA, Wang TS, Walker HD, Sosa JA. Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis. J Clin Endocrinol Metab 2008; 93: 2173-2180
    CrossrefPubMedGoogle Scholar