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. 2017 Apr;92(4):173-178.
doi: 10.4174/astr.2017.92.4.173. Epub 2017 Mar 24.

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

Yigit Turk  1 , Ozer Makay  1 , Murat Ozdemir  1 , Gozde Ertunc  1 , Batuhan Demir  1 , Gokhan Icoz  1 , Mahir Akyildiz  1 , Mustafa Yilmaz  1
Affiliations

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

Yigit Turk et al. Ann Surg Treat Res. 2017 Apr.

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.

Keywords: Calcitonin; Cytology; Thyroid nodule.

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Conflict of interest statement

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Medullary thyroid cancer located in the inferior zone of the right thyroid lobe (arrow).
Fig. 2
Fig. 2. Metastatic central lymph node of a medullary thyroid cancer case (arrow).
See this image and copyright information in PMC

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