Challenges in the diagnosis of patients with mild and moderate hypercalcitoninemia and nontoxic multinodular goiter

Raluca Trifanescu; Bogdan Ditescu; Niculescu Dan Alexandru; Dumitru Ioachim; Dana Terzea; Carmen Cristea; Catalina Poiana

doi:10.1530/endoabs.110.P509

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Endocrine Abstracts (2025) 110 P509 | DOI: 10.1530/endoabs.110.P509

ECEESPE2025 Poster Presentations Endocrine Related Cancer (76 abstracts)

Challenges in the diagnosis of patients with mild and moderate hypercalcitoninemia and nontoxic multinodular goiter

Raluca Trifanescu^{1, 2}, Bogdan Ditescu¹, Dan Alexandru Niculescu^{1, 2}, Dumitru Ioachim², Dana Terzea², Carmen Cristea² & Catalina Poiana^{1, 2}

Author affiliations

¹"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; ²"C. I. Parhon" National Institute of Endocrinology, Endocrinology I, Bucharest, Romania

JOINT3933

Background: correct diagnosis and management of patients with multinodular goiter and basal calcitonin between 10 and 100 pg/mL is challenging.

Patients and Methods: 4 patients (2 M/2W), aged 55-68 years, residents in an iodine-sufficient area, showing mild and moderate basal hypercalcitoninemia and multinodular goiter were presented. Basal serum calcitonin was measured by chemiluminescence. Calcitonin was also measured from the fine needle aspiration (FNA) washout fluid in suspicious thyroid nodules. A FNA cytology exam was performed in all patients according to guidelines and histology confirmed diagnosis in operated ones.

Results: All patients showed multinodular goiters, with nodules’ maximum diameters ranging from 1. 1-2. 9 cm. Serum basal calcitoninemia ranged from 1. 22 to 8. 14 × ULN. CEA was normal in all patients but one. Calcitonin measured from the fine needle aspiration washout fluid (FNA-Ctn) was normal (< 0. 5 – 0. 68 pg/mL) in all patients but one with increased value (25116 pg/mL). This patient had a large non-suspicious thyroid nodule (20/12. 3/13. 8 mm, EU-TIRADS 2) and a small suspicious nodule (6/5 mm, EU-TIRADS 4) in whom fine needle aspiration and measurement of FNA washout fluid was performed. Cytology exam and histology confirmed medullary microcarcinoma. RET assessment is pending In the other 3 patients with normal FNA-Ctn, cytology revealed Bethesda II cytology of the dominant nodule (n = 2) and papillary thyroid carcinoma -Bethesda V citology of the suspicious nodule (n = 1); the suspicious nodules were not accessible for FNA in 2 patients. Because a C cells hyperplasia could not be ruled out in these 3 patients, total thyroidectomy was performed. Pathology exam was medullary microcarcinoma in one patient, C cells hyperplasia in 2 patients, one of them also associating a papillary thyroid carcinoma. Postoperative serum calcitonin levels were normal in all patients.

Conclusion: in patients with mild and moderate hypercalcitoninemia, cytology exam and calcitonin measurement in the fine needle aspiration washout fluid, especially in highly suspicious nodules, irrespective of theirs dimensions, is a useful diagnosis tool.