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Nuklearmedizin 2008; 47(02): 65-72
DOI: 10.1055/s-0037-1621034
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Schattauer GmbH

Routine measurement of serum calcitonin in patients with nodular thyroid disorders?

Calcitonin-Screening bei der Knotenstruma?
M. Dietlein
1   Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. H. Schicha) der Universität zu Köln
,
H. Wieler
2   Abt. Nuklearmedizin (Leitender Arzt: Prof. Dr. H. Wieler), Bundeswehrzentralkrankenhaus und Klinikum Kemperhof gGmbH, Koblenz
,
M. Schmidt
1   Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. H. Schicha) der Universität zu Köln
,
R. Schwab
3   Abt. Allgemein-, Viszeral- und Thoraxchirurgie (Leitender Arzt: Prof. Dr. H. P. Becker), Bundeswehrzentralkrankenhaus Koblenz
,
P. E. Goretzki
4   Chirurgische Klinik I (Chefarzt: Prof. Dr. P. E. Goretzki), Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss
,
H. Schicha
1   Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. H. Schicha) der Universität zu Köln
› Author Affiliations
Further Information

Publication History

Eingegangen: 22 May 2007

angenommen nach Revision: 13 August 2007

Publication Date:
11 January 2018 (online)

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Summary

In spite of the fact that the German Society of Endocrinology has recommended calcitonin as screening-parameter the majority of physicians in Germany do not routinely use calcitonin in patients with thyroid nodules to exclude medullary thyroid cancer (MTC). The future revision of the recommendation should describe reference values for each commercially available assay, separately for men and women (basal and after pentagastrin-stimulation), and should define sonomorphological inclusion criteria. The epidemiological database of the prevalence of MTC is controversial and the specificity of basal elevated calcitonin levels is limited up to the 5-fold of the upper reference level. If renal insufficiency, bacterial infection, and an alcohol- or druginduced stimulation of calcitonin is excluded, hypercalcitoninaemia should be confirmed by a second measurement (if necessary using another assay). Stimulation of calcitonin by use of pentagastrin is mandatory prior to the decision on thyroidectomy. A stimulated calcitonin level <100 pg/ ml justifies “wait and see”. If stimulated calcitonin levels range between 100 and 200 pg/ml or higher, the differentiation between C-cell hyperplasia and MTC remains uncertain, especially in men. The implementation of calcitonin- screening requires the definition of sonographic inclusion criteria and validation of each assay. Additional prerequisites are excellent logistic (short period between blood sampling and start of the laboratory test), knowledge of differential diagnoses, knowledge of the consumption of drugs and alcohol, availability of pentagastrin-testing and of moleculargenetic testing with full information to the patients and sufficient time before the decision on surgery is made. All this and the choice of a skilled surgeon, experienced in thyroidectomy and lymphadenectomy with a low rate of local complications are the rationale to recommend calcitonin-screening primarily in centers for thyroid disorders.

Zusammenfassung

Trotz einer Empfehlung der Deutschen Gesellschaft für Endokrinologie zugunsten des Calcitonin-Screenings wird Calcitonin mit der Frage nach einem medullären Schilddrüsenkarzinom (MTC) bei Patienten mit Schilddrüsenknoten in Deutschland mehrheitlich nicht bestimmt. Bei der Fortentwicklung der Empfehlung zum Calcitonin-Screening sollten Assay-spezifische Referenzbereiche und die Geschlechtsspezifität des Calcitonin- Spiegels (basal und nach Pentagastrin-Stimulation) berücksichtigt und sonomorphologische Einschlusskriterien definiert werden. Unabhängig hiervon besteht eine epidemiologisch unklare Datenlage zur Prävalenz des MTC und eine begrenzte Spezifität eines basal erhöhten Calcitonin-Spiegels bis etwa zum Faktor 5 des oberen Referenzbereichs. Ist eine Niereninsuffizienz, eine bakterielle Infektion sowie eine Alkohol- oder medikamentös bedingte Stimulation des Calcitonins ausgeschlossen, sollte die Hypercalcitoninämie in einer zweiten Messung (ggf. mit einem anderen Assay) bestätigt werden. Vor einer Entscheidung über eine Thyroidektomie ist der Pentagastrintest notwendig. Ein stimulierter Calcitonin-Spiegel <100 pg/ml rechtfertigt ein kontrolliertes Zuwarten. Bei stimulierten Calcitonin- Werten zwischen 100 und 200 pg/ml, ggf. >200 pg/ml ist insbesondere bei Männern die Abgrenzung einer C-Zell-Hyperplasie gegen ein MTC nicht möglich. Die Etablierung eines sinnvollen Calcitonin-Screenings verlangt die Festlegung auf geeignete sonographische Einschlusskriterien und die Verwendung eines geeigneten Assays mit Validierung der Testergebnisse an einer genügend großen Patientenzahl. Dazu ist ein kurzes Zeitfenster zwischen Blutentnahme und Verarbeitung der Blutprobe, die Kenntnis der Differenzialdiagnosen, der Medikamenten- und der Alkoholanamnese, die Verfügbarkeit des Pentagastrintests und die Veranlassung einer molekulargenetischen Untersuchung notwendig, die eine Aufklärung des Patienten mit ausreichender Bedenkzeit vor Entscheidung über eine Operation einschließt. All dies und die Auswahl eines geeigneten Operateurs mit niedriger lokaler Komplikationsrate bei Thyroidektomie mit ggf. Lymph adenektomie sprechen für die Durchführung eines Calcitonin-Screenings vornehmlich nur an Schilddrüsenzentren.

Keywords

Calcitonin - screening - thyroid nodule - medullary thyroid cancer - C-cell hyperplasia

Schlüsselwörter

Calcitonin - Screening - Schilddrüsenknoten - medulläres Schilddrüsenkarzinom - C-Zell Hyperplasie
 

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