aspect of medical care is important and relevant for endocrinologists. We also believe that screening guidelines should be derived based on published medical evidence in consideration of relevant social, legal, and economic applications. However, at present, we do not think there is a sufficient medical or legal basis to recommend calcitonin screening in all patients with thyroid nodule(s). We are grateful to Dr. Deftos for the letter (1) that gives us the opportunity to make some observations regarding routine measurement of serum calcitonin (Ct) in patients with thyroid nodule(s). In our opinion, there are several lines of evidence (reviewed in Refs. 2 and 3) that support the serum Ct measurement in association with fine-needle aspiration cytology (FNAC) as the most accurate tests for discovering medullary thyroid carcinoma (MTC). In addition, our experience on more than 10,000 patients demonstrates that when MTC is diagnosed by Ct screening, it has a better outcome likely due to the statistically significant lower stage of the disease at the diagnosis (2). Unfortunately, Hodak and Burman (3) could not discuss this issue because our paper was published just before their editorial. It is known that MTC is the most aggressive differentiated thyroid tumor, with a survival rate of 50% at 10 yr, and that the best prognostic factor is the stage of disease, with intrathyroidal tumors showing the best prognosis (4). The possibility of performing an early MTC diagnosis offered by the routine serum Ct measurement must be taken into account if we want to improve our capability to cure a disease that can be definitively cured only by the completeness of the initial surgical treatment. It is in fact well known that nowadays conventional chemotherapy and radiotherapy are ineffective to cure advanced MTC (5).Serum Ct measurement is a reliable test when performed in referral centers that have accurately defined their own cut-off values for basal and pentagastrin-stimulated Ct. A detailed description of the method and its practical usefulness is very well described in the "Laboratory Medicine Practice Guidelines for the Diagnosis and Monitoring of Thyroid Disease," recently published in the official journal of the American Thyroid Association and validated by a total of 84 independent reviewers from different countries (6).One of the main arguments against the routine use of serum Ct measurement is the possibility of false-positive tests, particularly when baseline values are between 10 and 100 pg/ml. This is not the real scenario when the test is strictly applied to patients with thyroid nodules but not to other benign thyroid disorders, such as Hashimotos' thyroiditis, where confounding factors still exist. In our experience in more than 10,000 patients, all presenting with thyroid nodule(s), false-positive results were very rare, and, rather than false positive, they were due to other well-known benign conditions associated with increased serum Ct concentrations, such as renal failure, that can be easily recognized by caref...