Case Report: Medullary Thyroid Cancer Workup Initiated by Unexpectedly High Procalcitonin Level—Endocrine Training Saves Life in the COVID-19 Unit

Sira, Lívia; Balogh, Zoltán; Vitális, Eszter; Kovács, Dóra; Győry, Ferenc; Molnar, Călin; Bodor, Miklós; Nagy, Endre

doi:10.3389/fendo.2021.727320

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…However, PCT may be falsely increased in some neoplastic situations. Thus, some solid tumors (medullar carcinoma of the thyroid and small-cell lung cancer) as well as some hematological malignancies are thought to be associated with PCT positivity [ 21 – 24 ]. In our study cohort, 22.1% of the patients had cancer.…”

Section: Discussionmentioning

confidence: 99%

What Is the Place of Intermediate Care Unit in Patients with COVID-19? A Single Center Experience

Bülbül

Hakim

Ceylan

et al. 2023

International Journal of Clinical Practice

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Introduction. COVID-19 pandemic has led to an increased rate of intensive care unit (ICU) stays. Intermediate care units (IMCUs) are a useful resource for the management of patients with severe COVID-19 that do not require ICU admission. In this research, we aimed to determine survival outcomes and parameters predicting mortality in patients who have been admitted to IMCU. Materials and Methods. Patients who were admitted to IMCU between April 2019 and January 2021 were analyzed retrospectively. Sociodemographics, clinical characteristics, and blood parameters on admission were compared between the patients who died in IMCU and the others. Blood parameters at discharge were compared between survived and deceased individuals. Survival analysis was performed via Kaplan–Meier analysis. Blood parameters predicting mortality were determined by univariate and multivariate Cox regression analysis. Results. A total of 140 patients were included within the scope of this study. The median age was 72.5 years, and 77 (55%) of them were male and 63 (45%) of them were female. A total of 37 (26.4%) patients deceased in IMCU, and 40 patients (28.5%) were transferred to ICU. Higher platelet count (HR 3.454; 95% CI 1.383–8.625; p = 0.008 ), procalcitonin levels (HR 3.083; 95% CI 1.158–8.206; p = 0.024 ), and lower oxygen saturation (HR 4.121; 95% CI 2.018–8.414; p < 0.001 ) were associated with an increased risk of mortality in IMCU. At discharge from IMCU, higher procalcitonin levels (HR 2.809; 95% CI 1.216–6.487; p = 0.016 ), lower platelet count (HR 2.269; 95% CI 1.012–5.085; p = 0.047 ), and noninvasive mechanic ventilation requirement (HR 2.363; 95% CI 1.201–4.651; p = 0.013 ) were associated with an increased risk of mortality. Median OS was found as 41 days. The overall survival rate was found 40% while the IMCU survival rate was 73.6%. Conclusions. IMCU seems to have a positive effect on survival in patients with severe COVID-19 infection. Close monitoring of these parameters and early intervention may improve survival rates and outcomes.

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Section: Discussionmentioning

confidence: 99%

What Is the Place of Intermediate Care Unit in Patients with COVID-19? A Single Center Experience

Bülbül

Hakim

Ceylan

et al. 2023

International Journal of Clinical Practice

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“…However, because Pct is a more common investigation in a hospital setting due to its varied usefulness, there are some reports of MTC diagnosis due to elevated Pct. In the context of COVID-19 infection, two isolated case reports have been reported in Europe[ 19 , 20 ]. To the best of our knowledge, this is the first report from Asia of an incidental diagnosis of MTC due to persistently elevated Pct.…”

Section: Discussionmentioning

confidence: 99%

Incidental diagnosis of medullary thyroid carcinoma due to persistently elevated procalcitonin in a patient with COVID-19 pneumonia: A case report

Saha¹,

Mukhopadhyay²,

Paul³

et al. 2022

WJCC

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BACKGROUND Procalcitonin (Pct) is a common biomarker in clinical practice, especially in the era of coronavirus disease 2019 (COVID-19) infection. Although it is frequently used for the diagnosis and prognostication of bacterial infections or sepsis, it is also elevated in a few other conditions, including medullary thyroid carcinoma (MTC). CASE SUMMARY A 43-year-old female presented with moderately severe COVID-19 pneumonia in April 2021. She gradually recovered clinically; however, despite normalization of other inflammatory markers, Pct levels remained persistently elevated. Further workup identified the cause as left lobe MTC with locoregional metastasis. Calcitonin levels were high, and carcinoembryonic antigen levels were normal. The patient underwent total thyroidectomy and neck dissection, which was followed by another radical neck dissection due to residual disease. Currently, she is doing well, nearly having completed her course of external beam radiotherapy with no recurrence. Pct is well documented as a screening tool for MTC, especially because of its stable nature compared to calcitonin in the community settings. It is important to keep in mind the differential diagnosis of MTC in patients with persistently elevated Pct levels despite normal levels of other acute phase reactants. To the best of our knowledge, this is the first report from Asia of such an incidental diagnosis of MTC due to persistently elevated Pct levels in a patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CONCLUSION Persistently elevated Pct levels can occur in any pro-inflammatory state including infections, sepsis, or acute respiratory distress syndrome. In the current setting, SARS-CoV-2 infection is one such clinical scenario, and in rare situations of persistent elevation, MTC may need to be ruled out.

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“…Prognosis for malignant thyroid nodules largely depends on the type of cancer, tumor size and stage at diagnosis, as well as subsequent medical intervention 5 , 6 . Therefore, early and accurate differentiation of cancerous versus non-cancerous neoplasms is imperative for guiding clinical management of thyroid tumors 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

Deep learning-based cell segmentation for rapid optical cytopathology of thyroid cancer

Jermain,

Oswald,

Langdun

et al. 2024

Sci Rep

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Fluorescence polarization (Fpol) imaging of methylene blue (MB) is a promising quantitative approach to thyroid cancer detection. Clinical translation of MB Fpol technology requires reduction of the data analysis time that can be achieved via deep learning-based automated cell segmentation with a 2D U-Net convolutional neural network. The model was trained and tested using images of pathologically diverse human thyroid cells and evaluated by comparing the number of cells selected, segmented areas, and Fpol values obtained using automated (AU) and manual (MA) data processing methods. Overall, the model segmented 15.8% more cells than the human operator. Differences in AU and MA segmented cell areas varied between − 55.2 and + 31.0%, whereas differences in Fpol values varied from − 20.7 and + 10.7%. No statistically significant differences between AU and MA derived Fpol data were observed. The largest differences in Fpol values correlated with greatest discrepancies in AU versus MA segmented cell areas. Time required for auto-processing was reduced to 10 s versus one hour required for MA data processing. Implementation of the automated cell analysis makes quantitative fluorescence polarization-based diagnosis clinically feasible.

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Case Report: Medullary Thyroid Cancer Workup Initiated by Unexpectedly High Procalcitonin Level—Endocrine Training Saves Life in the COVID-19 Unit

Cited by 5 publications

References 10 publications

What Is the Place of Intermediate Care Unit in Patients with COVID-19? A Single Center Experience

What Is the Place of Intermediate Care Unit in Patients with COVID-19? A Single Center Experience

Incidental diagnosis of medullary thyroid carcinoma due to persistently elevated procalcitonin in a patient with COVID-19 pneumonia: A case report

Deep learning-based cell segmentation for rapid optical cytopathology of thyroid cancer

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