Calcitonin screening and pentagastrin testing: predictive value for diagnosis medullary carcinoma in nodular thyroid disease
Burkhard Herrmann1,2, Kurt Schmid4, Andreas Bockisch1, Mathias Kemen3 & Klaus Mann1
Context: Serum calcitonin (hCT) measurement may be useful for detecting medullary carcinoma (MTC), but the routine use of hCT and after pentagastrin stimulation to screen patients with nodular thyroid disease remains controversial.
Patients: One thousand and seven patients (667 females, 440 males) with nodular thyroid disease and a mean age of 55±14 (mean±S.D.) years were included in the study. All patients did not have impaired renal function, bacterial infection, alcohol- and drug-abuse, pseudohypoparathyroidism, or proton pump inhibitor therapy. Individuals referred with known elevation of hCT, Graves disease or autoimmune thyroid disease were not considered or included to be part of this investigation.
Methods: Serum hCT levels were determined under basal conditions, and when basal values were more than or equal to 10 and <100 pg/ml, testing was repeated after pentagastrin stimulation. Basal or stimulated levels more than 100 pg/ml were indicated for surgery.
Results: hCT levels >10 pg/ml were increased in 17 patients (1.7%). One patient had a basal hCT level of 4400 pg/ml with a histological confirmation of a MTC. In this patient, pentagastrin test was not performed. Sixteen patients with basal hCT between 10 and 100 pg/ml underwent pentagastrin-stimulated hCT measurement. 4/16 had stimulated hCT >100 pg/ml. 2/4 patients had MTC and 2 patients C cell hyperplasia. In sum, 3 patients (0.30%) had histological verified MTC.
Conclusions: Basal together with pentagastrin-stimulated hCT measurement in case of basal hCT >10 pg/ml detect MTC in 0.30% of patients with nodular thyroid disease and should be consider as a useful and recommended tool for early detection of MTC and to save the patients life.