Thresholds of Basal- and Calcium-Stimulated Calcitonin for Diagnosis of Thyroid Malignancy

Abstract

Since medullary thyroid carcinoma is an aggressive cancer, it is important to have an early detection based on stimulated calcitonin (CT), especially when basal-CT is slightly elevated. The objective of this work was to set specific thresholds for basal-CT- and calcium-stimulated calcitonin for prediction of thyroid malignancy in female population. The study included 2 groups: group A-women with elevated basal-CT (>9.82 pg/ml) and group B-women with normal basal-CT (control group). After calcium stimulation test precise protocol, histopathological reports of those that required surgery were correlated with both basal and stimulated calcitonin. The best basal and stimulated calcitonin cut-offs for distinguishing female patients with medullary thyroid carcinoma or C-Cell-hyperplasia from other pathologies or normal cases were: 12.9 pg/ml, respectively 285.25 pg/ml. For basal-CT above 30 pg/ml, malignancy was diagnosed in 9/9 patients (100%): 9 MTC. For stimulated calcitonin above 300 pg/ml, malignancy was diagnosed in 17/21 patients (80.95%): 12 MTC and 5 papillary thyroid carcinomas. The smallest nodule that proved to be medullary thyroid carcinoma had only 0.56/0.34/0.44 cm on ultrasound, with no other sonographic suspicious criteria. In conclusion, we have identified in Romanian female population basal and stimulated calcitonin thresholds to discriminate medullary thyroid carcinoma or C-Cell-hyperplasia from other cases. We recommend thyroid surgery in all women with stimulated calcitonin above 285 pg/ml. Further studies on larger groups are necessary to establish and confirm male and female cut-offs for early diagnosis of medullary thyroid carcinoma, and interestingly, maybe for macro-papillary thyroid carcinomas alike. The calcium administration has minimum side-effects, but continuous cardiac monitoring is required.

The role of [18F]F-DOPA PET/CT in diagnostic and prognostic assessment of medullary thyroid cancer: a 15-year experience with 109 patients

“…The Ct concentrations were determined with an immunochemiluminescence assay (ICMA) from Diagnostic Products Corporation (DPC, Los Angeles, CA), as described previously [3]. The ICMA results of this study were comparable with findings in other studies due to the worldwide use in many publications [14,15]. Blood samples for sCt determination during calcium-stimulated test (CST) were performed according to our previous publication described in detail [3].…”

Does pretreatment elevated calcitonin level cause the poor prognosis in patients with medullary thyroid cancer?

“…The application of serum Ctn levels has greatly helped in the diagnosis of MTC, especially in fine-needle aspiration (FNA) (19). Calcium stimulation (20,21) and pentagastrin (PG) (20,22) can be used to assist Ctn in differentiating C cell proliferation and MTC. Our previous study (23) (25) demonstrated that preoperative Ctn level, preoperative CEA level, and TNM stage were negatively correlated with biochemical cure.…”

Post-thyroidectomy hypocalcemia and related complications

“…Although other factors have been described as stimulating calcitonin secretion, pentagastrin (mainly) and the administration of venous calcium are true secretagogues, being important agents for the clinical evaluation of calcitonin secretion by normal and neoplastic cells (Wondisford, 2020;Wong, Nabata, & Wiseman, 2022). Some authors suggested that calcitonin is also responsible for the alteration of the postoperative calcium concentration in thyroidectomies (Băetu, Olariu, Nițu, et al, 2021;Băetu, Olariu, Stancu, et al, 2021;Tausanovic et al, 2021). Manipulation of the thyroid gland would lead to an increase in calcitonin secretion and, consequently, to a decline in calcium.…”