Routine calcitonin measurement in nodular thyroid disease management: is it worthwhile?.
10.4174/astr.2017.92.4.173
- Author:
Yigit TURK
1
;
Ozer MAKAY
;
Murat OZDEMIR
;
Gozde ERTUNC
;
Batuhan DEMIR
;
Gokhan ICOZ
;
Mahir AKYILDIZ
;
Mustafa YILMAZ
Author Information
1. Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey. ozer.makay@ege.edu.tr
- Publication Type:Original Article
- Keywords:
Thyroid nodule;
Calcitonin;
Cytology
- MeSH:
Calcitonin*;
Diagnosis;
Hashimoto Disease;
Humans;
Pentagastrin;
Renal Insufficiency;
Thyroid Diseases*;
Thyroid Gland*;
Thyroid Neoplasms;
Thyroid Nodule
- From:Annals of Surgical Treatment and Research
2017;92(4):173-178
- CountryRepublic of Korea
- Language:English
-
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.
