The Use of Preoperative Routine Measurement of Basal Serum Thyrocalcitonin in Candidates for Thyroidectomy due to Nodular Thyroid Disorders: Results from 2733 Consecutive Patients

Abstract

Routine measurement of CT in the preoperative work-up of nodular thyroid disorders is useful. This procedure improves intraoperative diagnosis of MTC and enables adapted initial surgery, the most determinant factor of treatment success.

The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions

“…Among the available diagnostic tools for MTC, serum calcitonin level measurement has been the most commonly used due to its higher sensitivity for MTC than FNA cytology. [11][12][13] Because the appropriate use of serum calcitonin level measurement is helpful for detecting unsuspected MTC, it is commonly used in patients with thyroid nodules to prevent the risk of a false-negative cytologic diagnosis. Patients with a serum calcitonin level of Ն100 pg/mL are strongly recommended for surgery, even though the cytologic diagnosis is not fulfilled for MTC under the current guidelines.…”

“…10,11 Serum calcitonin level measurement in patients with thyroid nodules is a sensitive and specific marker with even better diagnostic accuracy than cytology in unsuspected MTC, though the routine measurement of serum calcitonin levels in nodular thyroid disease and the cutoff value for a diagnosis of MTC are still debatable. [11][12][13] Due to these diagnostic difficulties, some MTC is still incidentally discovered after a diagnostic operation or after an operation with an incorrect presurgical diagnosis-this situation presents the risk of an incomplete therapeutic approach and a less favorable prognosis. 10,14,15 Therefore, early and accurate diagnosis of MTC is of crucial importance for optimal management.…”

Usefulness of preoperative serum calcitonin in patients with nodular thyroid disease without suspicious history or cytology for medullary thyroid carcinoma

“…Whereas sporadic MTC is very unlikely in the presence of basal sCT < 10 pg/mL (9,10), serum concentration > 100 pg/mL has an excellent positive predictive value (PPV) for this tumor in the absence of any apparent cause (e.g., chronic renal failure, use of proton pump inhibitors, other known secretory tumors) (6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), and stimulation tests are not necessary in these cases. Despite the traditional cutoff value of 100 pg/mL, at least in women, PPV of 100% was reported in many series for basal sCT > 60 pg/mL (6,(8)(9)(10)(12)(13)(14)(17)(18)(19)(20)(21). In agreement with this finding, in the present study, after known causes of hypercalcitoninemia were excluded, none of the 492 patients without MTC had basal sCT > 40 pg/mL.…”

Medullary Thyroid Carcinoma: Why Is Specialization Mandatory?

“…In female patients with calcitonin levels ≥ 35 pg/ml and male patients with calcitonin levels ≥ 46 pg/ml, the risk for MTC is considered to be markedly elevated [20]. Other studies defined 60-65 pg/ml as cut-off values of calcitonin to detect MTC [21,22]. Earlier detection of MTC leads to better biochemical cure rates, as shown by Machens and Dralle in 2015 [17].…”