Mild hypercalcitoninaemia and sporadic thyroid disease.
BACKGROUND
Not operating on patients with mild hypercalcitoninaemia (MHCT) and sporadic thyroid disease carries the risk of omitting curative surgery for medullary thyroid cancer, but systematic surgery would result in unnecessary treatment of benign pathology. This study reviewed the management of MCHT and non-hereditary thyroid disease in one centre.


METHODS
MCHT was defined as an increase in basal and stimulated calcitonin levels not exceeding 30 and 200 pg/ml respectively. Over 15 years, 125 patients who presented with MCHT and sporadic thyroid disease were followed. Surgery was indicated only if there were local pressure symptoms or suspicious histomorphological changes in solitary nodules.


RESULTS
Fifty-five patients underwent total thyroidectomy and 18 unilateral total lobectomy. Histological examination revealed medullary microcarcinoma in six patients (two women and four men). C-cell hyperplasia was found in 54 patients (74 per cent) and 13 (18 per cent) harboured no C-cell pathology. Calcitonin levels stabilized after lobectomy and became undetectable following thyroidectomy. They normalized during follow-up in a third of patients who did not have surgery.


CONCLUSIONS
Not all patients with MHCT and sporadic thyroid disease require surgery.
Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France.
M
M
Cherenko
E
E
Slotema
F
F
Sebag
C
C
De Micco
J F
JF
Henry
D014408:Biomarkers, Tumor / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D018276:Carcinoma, Medullary / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D013959:Thyroid Diseases / Q000175:diagnosis* / Q000601:surgery; D013961:Thyroid Gland / Q000473:pathology* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000175:diagnosis; D013965:Thyroidectomy; D019564:Unnecessary Procedures
D014408:Biomarkers, Tumor; D002116:Calcitonin