LNSLNS

We thank our correspondents for their contribution, which provides important additional information regarding the problem of raised serum calcitonin and the associated suspected presence of a medullary thyroid carcinoma (MTC).

Our correspondents highlight in a concise way the current problems with the available data, and we fully agree with their comments. As our article (1) was, however, subject to a definite word limit and MTC accounts for less than 10% of all thyroid cancers, we were not able to conduct a comprehensive discussion of the subject. We—as coauthors of the cited article by S Allelein et al. (2)—are fully aware of the blurred delineation between suspicious findings and confirmation of an MTC of prognostic relevance, based on the baseline calcitonin concentration. In this context, the factors of influence pointed out by our correspondents—sex and the assay used for testing—are of enormous relevance.

As MTC is, however, in any case a disorder that should conscientiously be excluded or confirmed pre-surgery, we, as surgeons and nuclear medicine specialists, recommend in cases of doubt a second opinion from an endocrinologist and to confirm the laboratory findings in a repeat test. If the suspected finding of MTC is confirmed, further investigations may be required to confirm or rule out a possible familial disorder (multiple endocrine neoplasia type 2).

DOI: 10.3238/arztebl.2018.0221b

Prof. Dr. med. Detlef K. Bartsch
Klinik für Visceral-, Thorax- und Gefäßchirurgie
Universitätsklinikum Gießen und Marburg GmbH
Standort Marburg
bartsch@med.uni-marburg.de

Prof. Dr. med. Markus Luster
Klinik für Nuklearmedizin
Universitätsklinikum Gießen und Marburg GmbH
Standort Marburg

Prof. Dr. med. Peter E. Goretzki
Klinik für Allgemein-, Viszeral- und Endokrine Chirurgie
Lukaskrankenhaus Neuss

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

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.
Allelein S, Ehlers M, Morneau C, et al.: Measurement of basal serum ßcalcitonin for the diagnosis of medullary thyroid cancer. Horm Metab Res 2018; 50: 23–8. CrossRef MEDLINE
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.Allelein S, Ehlers M, Morneau C, et al.: Measurement of basal serum ßcalcitonin for the diagnosis of medullary thyroid cancer. Horm Metab Res 2018; 50: 23–8. CrossRef MEDLINE

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