The Timing of Total Thyroidectomy inRETGene Mutation Carriers Could Be Personalized and Safely Planned on the Basis of Serum Calcitonin: 18 Years Experience at One Single Center
| Autor: | Clara Ugolini, Giulia Renzini, Cristina Romei, Fulvio Basolo, Laura Agate, Valeria Bottici, Pinuccia Faviana, Piero Berti, Paolo Miccoli, Barbara Cosci, Aldo Pinchera, Virginia Cappagli, Paolo Vitti, Eleonora Molinaro, Rossella Elisei |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Calcitonin Male Heterozygote medicine.medical_specialty Time Factors Adolescent Medullary cavity Endocrinology Diabetes and Metabolism medicine.medical_treatment Clinical Biochemistry Single Center Biochemistry Patient Care Planning Thyroid carcinoma Young Adult Basal (phylogenetics) Endocrinology Internal medicine 80 and over medicine Humans Thyroid Neoplasms Precision Medicine Child Preschool Aged Retrospective Studies Aged 80 and over Child Preschool Female Follow-Up Studies Individualized Medicine Middle Aged Mutation Patient Safety Proto-Oncogene Proteins c-ret Thyroidectomy Biochemistry (medical) business.industry RET Gene Mutation Retrospective cohort study Carcinoma Neuroendocrine Diabetes and Metabolism business |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 97:426-435 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/jc.2011-2046 |
| Popis: | Medullary thyroid carcinoma (MTC) is a calcitonin (CT)-producing C-cell tumor. In hereditary cases, a germline RET mutation is found in 98% of families. Because MTC is cured only if intrathyroidal, prophylactic thyroidectomy is recommended in the gene carrier (GC).The aim was to determine whether thyroidectomy performed when stimulated CT becomes detectable is as safe as prophylactic thyroidectomy and to identify the serum CT cutoff able to distinguish intrathyroidal from extrathyroidal MTC.Eighty-four GC were prospectively enrolled; 53 of the 84 underwent total thyroidectomy, one refused surgery, and 30 with normal basal and stimulated CT were under surveillance. The follow-up ranged from 2 to 18 yr.GC operated on for elevated stimulated CT included 27 GC with a positive peak CT at the screening and four cases who became positive after 4 yr. All of them had intrathyroidal MTC and no node metastases; all were cured after a mean follow-up of 7.5 yr. Among those operated on for detectable basal CT, intrathyroidal tumors were found when CT was below 60 pg/ml, whereas either node metastases or larger tumors were observed when CT was above 60 pg/ml. No correlation among serum CT, age, and type of RET mutation was observed. Thirty GC were still biochemically negative at the annual control.The time of thyroidectomy in GC with negative CT could be personalized and safely planned when stimulated CT becomes positive, independent of the type of RET mutation and patient's age. In this series, a basal CT below 60 pg/ml was always associated to an intrathyroidal localization of MTC. |
| Databáze: | OpenAIRE |
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