Calcitonin Measurement to Detect Medullary Thyroid Carcinoma in Nodular Goiter: German Evidence-Based Consensus Recommendation
| Autor: | Henning Dralle, Friedhelm Raue, M. Hüfner, M. Grussendorf, Klaus Mann, Georg Brabant, Christoph Reiners, Bruno Niederle, Wolfram Karges |
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| Rok vydání: | 2004 |
| Předmět: |
Calcitonin
medicine.medical_specialty Pathology Goiter endocrine system diseases Endocrinology Diabetes and Metabolism medicine.medical_treatment Gastroenterology Thyroid carcinoma Endocrinology Internal medicine Internal Medicine medicine Humans Thyroid Neoplasms Thyroid cancer Immunoassay business.industry Thyroid Thyroidectomy Medullary thyroid cancer General Medicine medicine.disease medicine.anatomical_structure Medullary carcinoma Carcinoma Medullary Practice Guidelines as Topic Pentagastrin business Goiter Nodular |
| Zdroj: | Experimental and Clinical Endocrinology & Diabetes. 112:52-58 |
| ISSN: | 1439-3646 0947-7349 |
| DOI: | 10.1055/s-2004-815727 |
| Popis: | Serum calcitonin (CT) has become a very specific and sensitive marker for human medullary thyroid carcinoma (MTC), a neuroendocrine tumor affecting about 1 % of patients with nodular thyroid disease. MTC is characterized by early micrometastasis and a lack of curative non-surgical treatment, so that early diagnosis is desirable. Based on a systematic review of scientific evidence, we propose multidisciplinary consensus recommendations for the clinical use of CT in patients with nodular goiter. To exclude MTC, serum CT should be determined in patients with nodular thyroid disease, using a two-site CT immunoassay. If basal serum CT exceeds 10 pg/ml, CT should be analysed by pentagastrin stimulation testing, after renal insufficiency and proton pump inhibitor medication have been ruled out. As the risk for MTC is higher than 50 % in patients with stimulated CT values > 100 pg/ml, thyroidectomy is advised in these individuals. If stimulated CT exceeds 200 pg/ml, thyroidectomy and lymphadenectomy is strongly recommended. Pentagastrin-stimulated CT values < 100 pg/ml are associated with a low risk of MTC, or very rarely, non-metastasizing micro-MTC (size < 10 mm). Therefore, regular clinical and biochemical follow-up is the preferred treatment in such patients, unless thyroid malignancy is suspected otherwise. |
| Databáze: | OpenAIRE |
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