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Padma K. Horvit, Robert F. Gagel, The Goitrous Patient with an Elevated Serum Calcitonin—What to Do?, The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 2, 1 February 1997, Pages 335–337, https://doi.org/10.1210/jcem.82.2.3788
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What is the risk of medullary thyroid carcinoma in a patient who presents with nodular thyroid disease? More importantly, is it possible to identify medullary thyroid carcinoma at a stage of development when cure is possible? There have never been satisfactory answers to these questions because techniques for routine evaluation of thyroid nodules, including fine needle aspiration (FNA), are inadequate for detection of medullary thyroid carcinoma in its earliest stages. A marked elevation of the serum calcitonin concentration is a specific marker for medullary thyroid carcinoma, but there has been debate over the significance of a minimal elevation of the serum calcitonin. So the question remains, should basal serum calcitonin measurements be part of the routine evaluation of a thyroid nodule or nodular goiter?
Several reports over the past 2 yr employing sensitive and specific calcitonin assays provide some answers. Reports from Pacini et al. (1), Rieu et al. (2), and a study in this issue of JCEM (3) (see page 338) have evaluated the significance of basal serum calcitonin measurements in over 3,000 patients with nodular thyroid disease. The first 2 reports are similar in that patients with elevated basal calcitonin levels or abnormal FNA results underwent surgical exploration of the thyroid gland. In the study by Pacini et al. (1), 8 of 1,385 patients had elevated basal calcitonin levels ranging from 55–10,000 pg/mL. In the study by Rieu et al. (2), 4 of 469 patients had elevated basal calcitonin levels ranging from 70–2,838 pg/mL. All patients in these 2 studies with an elevated basal calcitonin, as defined in the individual assay, were found to have medullary thyroid carcinoma (MTC). Equally important, only 3 of 12 patients identified with MTC by calcitonin measurements would have been identified by fine needle aspiration.
