Calcitonin Screening in Nodular Goiter—Upper Limits
In the description of calcitonin screening in nodular goiter, the specific dimension has to be considered when reporting the upper-limit values (conversion factor for calcitonin pg/mL×0.28=pmol/L); this was corrected in issue 9. The article (1) reported a 95% probability for the presence of medullary thyroid carcinoma for limits of >26 pg/mL in women and >60 pg/mL in men—these data came from an original article by Mian et al. (2). Mian et al. used a receiver-operating characteristic curve (ROC) analysis of baseline calcitonin concentrations to test the best method for distinguishing normal persons and patients with medullary thyroid carcinoma and calculated a cut-off value of >26 pg/mL for women and >68 pg/mL for men.
When sensitivity and specificity were taken into account, the sex-specific upper limits for baseline calcitonin concentrations that led to a recommendation to operate on the suspected sporadic medullary thyroid carcinoma (MTC) were ca. 30 pg/mL in women and ca. 60 pg/mL in men. These cut-offs were measured by using the newer calcitonin assays and were also confirmed by other working groups (3, 4). This means a grey area for calcitonin of 20–30 pg/mL in women and 30–60 pg/mL in men, where 6–13% of smaller MTC were missed, but C-cell hyperplasia was diagnosed just as often. This uncertainty can be overcome by checking calcitonin concentrations at 3–6 month intervals. Increasing calcitonin concentrations may indicate an MTC—in which case one should operate. There is no great urgency, however, since thyroidectomy can cure MTC in almost 100% of cases where the calcitonin concentration is below 100 pg/mL. Calcitonin screening should also be undertaken in any nodule that is smaller than 1 cm. MTC of a size of 0.4–0.6 cm tend to be associated with calcitonin concentrations of 20–100 pg/mL.
Prof. Dr. med. Friedhelm Raue
Prof. Dr. med Karin Frank-Raue
|1.||Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE on behalf of the German Society for General and Visceral Surgery quality commission: Indications for the surgical management of benign goiter in adults. Dtsch Arztebl Int 2018; 115: 1–7 VOLLTEXT|
|2.||Mian C, Perrino M, Colombo C, et al.: Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety. |
J Clin Endocrinol Metab 2014; 99: 1656–64 CrossRef MEDLINE
|3.||Allelein S, Ehlers M, Morneau C, et al.: Measurement of basal serum calcitonin for the diagnosis of medullary thyroid cancer. Horm Metab Res 2018; 50: 23–8 CrossRef MEDLINE|
|4.||Rosario PW, Calsolari MR: 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. Horm Metab Res 2016; 48: 372–6 CrossRef MEDLINE|