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DOI: 10.1055/s-2001-18020
Welche Relevanz haben leicht erhöhte, nicht hereditär bedingte, Kalzitoninkonzentrationen vor Schilddrüsenoperationen?[*]
Clinical relevance of slightly elevated calcitonin levels in non hereditary, non-MEN thyroid diseasePublication History
Publication Date:
26 October 2001 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200106/lookinside/thumbnails/10.1055-s-2001-18020-1.jpg)
Zusammenfassung.
Mit der Verbreitung des Kalzitoninscreenings in der Schilddrüsendiagnostik beobachten wir zunehmend Patienten mit Knotenstrumen und geringfügig erhöhtem Kalzitonin (CT). Ziel der Studie war die Evaluation der klinischen Relevanz und der histologischen Korrelate derart grenzwertiger Kalzitoninerhöhungen (bis zum 5fachen der Norm). Patienten und Methode: Zwischen 07/1997 und 09/2000 wurden in unserer Klinik 39 Patienten (21 Frauen, 18 Männer, 27 - 68 Jahre, Median 47 Jahre) mit geringfüger Kalzitoninerhöhung operiert. In dem genannten Zeitraum wurden 1800 Schilddrüsenoperationen in unserer Klinik durchgeführt, ein systematisches Kalzitoninscreening erfolgte nicht. Ergebnisse: Das präoperative basale CT lag bei den Männern zwischen 11,6 und 37,6 pg/ml (Norm < 11,5) und nach Pentagastrinstimulation zwischen 45,6 und 286 pg/ml. Bei den Frauen basal zwischen 5,0 und 25,9 pg/ml (Norm < 4,6) und stimuliert zwischen 19 und 101 pg/ml. Bei 9 (23,1 %) der Patienten wurde eine totale Thyreoidektomie, bei 26 (66,7 %) eine Lobektomie und Resektion der Gegenseite und bei 4 (10,2 %) eine Hemithyreoidektomie durchgeführt. Die konventionelle Histologie (HE-Färbung) zeigte bei einer Patientin ein unifokales Mikro-C-Zell-Karzinom (Durchmesser 2 mm), bei 38 (97,5 %) keinen pathologischen Befund der C-Zellen. Immunhistochemisch fand sich bei 11 Patienten (28,2 %) eine C-Zell-Hyperplasie (CCH). Die Prävalenz der CCH war signifikant (p < 0,05/Chi-Quadrat-Test) erhöht bei Patienten mit einem stimulierten CT über 100 pg/ml. Postoperativ normalisierte sich das CT bei 38 Patienten. Das genetische MEN/FMTC-Screening, durchgeführt bei allen 11 Patienten mit einer CCH, war negativ. Schlussfolgerung: Im Einzelfall kann eine grenzwertige CT-Erhöhung auf ein Mikro-C-Zell-Karzinom hinweisen. In der überwiegenden Mehrzahl der Patienten (97,5 %) war diese jedoch von fraglicher klinischer Relevanz. Es besteht sicher kein Zusammenhang zwischen einem klinisch fassbaren Knoten und derart geringen CT-Konzentrationen. Grenzwertiges Kalzitonin allein begründet nach unseren Ergebnissen nicht die Forderung nach totaler Thyreoidektomie. Um unnötige totale Thyreoidektomien zu vermeiden, sollten, unter Berücksichtigung der C-Zell-Anatomie, Areale ohne oder mit lediglich geringer C-Zell-Dichte evaluiert werden.
Clinical relevance of slightly elevated calcitonin levels in non hereditary, non-MEN thyroid disease.
The importance of slightly elevated serum calcitonin levels (CT) in hereditary diseases (MEN II/ FMTC) or in the follow-up of patients operated for medullary thyroid carcinoma (MTC) is proven. But with routine-measurement of CT in thyroid diagnostics we observe more patients with nodular goiter and slightly elevated serum CT without hereditary disease. Aim of the study was to assess the clinical relevance and histological findings in patients with borderline or slightly elevated basal CT (up to 5 fold of normal). Patients and Methods: From 07/97 to 09/00 39 patients (21 female, 18 male, age 27 to 68 years, median 47 years) with slightly elevated basal CT were operated on. During this period 1800 operations for nodular goiter were performed in our institute. Results: The preoperative basal CT in male patients ranged from 11,6 to 37,6 pg/ml (normal value under 11,6). Stimulated CT (Pentagastrin 0,5 µg/kg/bw) ranged from 45,6 to 286 pg/ml. In female patients basal CT ranged from 5,0 to 25,9 pg/ml (normal < 4,6) and stimulated CT from 19 to 101 pg/ml. In 9 (23,1 %) patients a total thyroidectomy was performed. 26 (66,7 %) patients were treated with unilateral total lobectomy and contralateral partial lobectomy. Hemithyroidectomy only was performed in 4 (10,2 %) patients. The conventional histologic examination (HE-staining) showed in one (2,5 %) female patient an unifocal micro MTC (2 mm diameter). All other patients (97,5 %) were not suspicious of MTC. In immunohistology 11 (28,2 %) patients were positive for C-Cell-Hyperplasia (CCH) including the one patient with MTC. The prevalence of CCH was significantly (p < 0,05) increased in patients with a stimulated CT higher than 100 pg/ml. After surgery in 38 out of 39 patients the basal CT levels returned to normal. There was no statistically significant correlation between the postoperative CT levels and the chosen surgical procedure. The genetic MEN/FMTC-screening performed in all patients with MTC or positive immunostaining for CCH was negative. Conclusion: Slightly elevated CT can indicate a micro-MTC exceptionally. In most patients (97,5 %) these CT-elevations are of questionable clinical relevance. There is no correlation between a clinically detected hypofunctional thyroid nodule and slightly elevated CT. The latter does not justify a total thyroidectomy by itself. To avoid total thyroidectomies on one hand, overlooked C-Cell-pathology on the other hand, operative procedures, leaving areas without or with very low C-Cell-density, should be developed.
Schlüsselwörter:
Kalzitonin - Medulläres Schilddrüsenkarzinom - C-Zell-Hyperplasie - Schilddrüsenchirurgie
Key words:
Calcitonin - Medullary thyroid carcinoma - C-cell-hyperplasia - Thyroid surgery
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1 Herrn Prof. H.-D. Röher zum 65. Geburtstag gewidmet.
Prof. Dr. med. R. A. Wahl
Bürgerhospital Frankfurt am Main e. V.
Chirurgische Klinik
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