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. 2022 Jun;77(1):80-85.
doi: 10.1007/s12020-022-03047-2. Epub 2022 Apr 7.

The dilemma of routine testing for calcitonin thyroid nodule's patients to detect or exclude medullary carcinoma: one single negative test should be valuable as rule-out strategy to avoid further calcitonin measurements over time

Pierpaolo Trimboli  1   2 , Chiara Camponovo  3 , Lorenzo Ruinelli  4
Affiliations

The dilemma of routine testing for calcitonin thyroid nodule's patients to detect or exclude medullary carcinoma: one single negative test should be valuable as rule-out strategy to avoid further calcitonin measurements over time

Pierpaolo Trimboli et al. Endocrine. 2022 Jun.

Abstract

Purpose: While calcitonin (CT) measurement is recognized as the most accurate tool to diagnose medullary thyroid carcinoma (MTC), its routine use in patients with thyroid nodule (TN) is not universally accepted. The present study raised the question whether a TN patient with an initial normal CT can have suspicious CT levels (i.e., at least >20 pg/ml) later during his follow-up.

Methods: The historical database of our institution was searched to select TN patients undergone multiple CT tests, having an initial normal CT, and clinically followed up for years. The event of a CT above 20 pg/ml (mild-to-moderate suspicion) and 100 pg/ml (high suspicion) was searched in the follow-up of the included patients.

Results: According to the study design, the study sample encompassed 170 patients (131 female, 39 male) with initial CT value ≤10 pg/ml. On the first CT test, patients were 54.8 years and median CT was 2.1 pg/ml in both females and males. Over a period of 14.5 years and a median clinical follow-up of patients of 53.0 (23.9-102.5) months, MTC could be excluded by histology or cytology in 109 (64%) and clinically in the remaining ones. On the follow-up over time, no patients had CT >20 pg/ml and only two cases had CT just above 10 pg/ml.

Conclusion: According to the present results, one single CT testing with normal value could be reasonably used as a rule-out strategy in patients with TN to avoid further CT measurements.

Keywords: Calcitonin; Medullary thyroid carcinoma; Routine testing; Thyroid nodule.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of CT values at first and last test. The wideness of violin indicates the density of cases with the same CT value. The height of violin indicates the ranges of CT values
Fig. 2
Fig. 2
CT results in all patients of the study series according to their age on the time of each test. In y axis the Id of any patient and in x axis her/his age in years. Each patient is represented by a horizontal line with color according to her/his gender. Dot indicates CT tests with value ≤10 pg/ml. X represents CT test >10 pg/ml. Gray line represents the overall period of clinical follow-up
See this image and copyright information in PMC

References

    1. Tuttle RM, Ball DW, Byrd D, et al. Medullary carcinoma. J. Natl Compr. Canc Netw. 2010;8:512–530. doi: 10.6004/jnccn.2010.0040. - DOI - PubMed
    1. Trimboli P, Giovanella L, Crescenzi A, Romanelli F, Valabrega S, Spriano G, Cremonini N, Guglielmi R, Papini E. Medullary thyroid cancer diagnosis: an appraisal. Head. Neck. 2014;36(8 Aug):1216–1223. doi: 10.1002/hed.23449. - DOI - PubMed
    1. Elisei R, Romei C. Calcitonin estimation in patients with nodular goiter and its significance for early detection of MTC: european comments to the guidelines of the American Thyroid Association. Thyroid Res. 2013;6 Suppl 1(Suppl 1 Mar):S2. doi: 10.1186/1756-6614-6-S1-S2. - DOI - PMC - PubMed
    1. Schlumberger M, Bastholt L, Dralle H, Jarzab B, Pacini F, Smit JWA. European Thyroid Association guidelines for metastatic medullary thyroid cancer. Eur. Thyroid J. 2012;2012(1):5–14. doi: 10.1159/000336977. - DOI - PMC - PubMed
    1. Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009;19:565–612. doi: 10.1089/thy.2008.0403. - DOI - PubMed

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