Frequency and Relevance of Elevated Calcitonin Levels in Patients with Neoplastic and Nonneoplastic Thyroid Disease and in Healthy Subjects
Georgios Karanikas,
Abbas Moameni,
Christian Poetzi,
Georg Zettinig,
Klaus Kaserer,
Christian Bieglmayer,
Bruno Niederle,
Robert Dudczak and
Christian Pirich
Departments of Nuclear Medicine and Clinical Pathology, Institute for Medical and Chemical Laboratory Diagnostics, and Department of Surgery, Section of Endocrine Surgery, Division of General Surgery, University of Vienna, A-1090 Vienna, Austria
Address all correspondence and requests for reprints to: Dr. Georgios Karanikas, Department of Nuclear Medicine, University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria. E-mail: georg.karanikas{at}akh-wien.ac.at.
Routine measurement of serum calcitonin (CT) has been recentlyproposed for all patients with neoplastic thyroid disease todetect clinically occult medullary thyroid carcinoma (MTC).Data on the prevalence of elevated CT levels in nonneoplasticthyroid disease or in healthy subjects have not been reportedto date. Four hundred and fourteen consecutive patients withsuspected thyroid disease and 362 healthy controls underwentthyroid examination with measurement of basal serum CT. Wheneverserum CT was 10 pg/ml or more, a pentagastrin (PG) stimulationtest was performed. Twenty-eight of 414 patients (6.8%) showedelevated basal serum CT levels, 15 of them with nonneoplasticthyroid disease, and the remaining 13 subjects with neoplasticthyroid disease. Four patients with abnormal PG testing (stimulatedCT, 100 pg/ml) were identified. Three of themhad biochemical and sonographical evidence of thyroiditis. Elevatedbasal CT levels were significantly more frequent in patientswith Hashimoto’s thyroiditis (HT; P < 0.05). One femalepatient with HT had a 5-mm nodule, which was classified as MTC.None of the 6 out of 362 healthy controls with elevated basalCT (1.7%) presented an abnormal PG test. Our data suggest thatbasal CT measurements can be of use in the detection/screeningof MTC not only in subjects with neoplastic thyroid disorders,but also in patients with immunological evidence of HT. Theyalso confirm earlier reports on the essential value of PG stimulationtesting, even when basal plasma CT levels are only modestlyelevated, with regard to establishing the diagnosis of MTC orits premalignant associated conditions (micro-MTC and neoplasticC cell hyperplasia).
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100 pg/ml) were identified. Three of them had biochemical and sonographical evidence of thyroiditis. Elevated basal CT levels were significantly more frequent in patients with Hashimoto’s thyroiditis (HT; P < 0.05). One female patient with HT had a 5-mm nodule, which was classified as MTC. None of the 6 out of 362 healthy controls with elevated basal CT (1.7%) presented an abnormal PG test. Our data suggest that basal CT measurements can be of use in the detection/screening of MTC not only in subjects with neoplastic thyroid disorders, but also in patients with immunological evidence of HT. They also confirm earlier reports on the essential value of PG stimulation testing, even when basal plasma CT levels are only modestly elevated, with regard to establishing the diagnosis of MTC or its premalignant associated conditions (micro-MTC and neoplastic C cell hyperplasia). 
