Routine measurement of plasma calcitonin in nodular thyroid diseases.
In a prospective study, plasma concentrations of human calcitonin (hCT) were determined in 1062 consecutive patients with thyroid nodular disease. Basal plasma hCT was above the normal range (>6 pg/mL) in 55 patients and was elevated up to more than 100 pg/mL (range, 127-5459) in 3 of these 55 patients. A pentagastrin-induced rise in hCT up to more than 100 pg/mL was observed in only 1 of 38 patients with a basal concentration of hCT between 5-10 pg/mL, but was found in 10 of 31 patients with basal hCT ranging from 10-100 pg/mL. Histologically, 7 of the 14 patients with either basal or stimulated plasma concentrations of hCT above 100 pg/mL presented C cell hyperplasia, which in one case showed histological transition into a small (diameter, 3 mm) medullary thyroid carcinoma (MTC). Including this patient, MTC was found in 6 of the 12 patients. We conclude that the routine determination of hCT in all patients with thyroid nodular disease should be supplemented by pentagastrin-stimulation when the basal hCT concentration exceeds 10 pg/mL. Patients with basal and/or stimulated plasma CT concentrations of more than 100 pg/mL should be operated on because they run a substantial risk to suffer either MTC or C cell hyperplasia, a potentially precancerous condition. This will increase the chance of a timely diagnosis of MTC and provide the chance of curative surgery.
Vierhapper
H
H
Department of Internal Medicine III, University of Vienna, and St. Anna Kinderspital, Austria.
Raber
W
W
Bieglmayer
C
C
Kaserer
K
K
Weinhäusl
A
A
Niederle
B
B
D002116:Calcitonin / Q000097:blood*; D018276:Carcinoma, Medullary / Q000097:blood / Q000473:pathology / Q000601:surgery; D006801:Humans; D006965:Hyperplasia; D010418:Pentagastrin; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000097:blood* / Q000473:pathology; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000097:blood / Q000473:pathology
D002116:Calcitonin; D010418:Pentagastrin