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This version published online on January 5, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-1836
A more recent version of this article appeared on April 1, 2005
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Submitted on September 15, 2004
Accepted on December 28, 2004

Prospects of Remission in Medullary Thyroid Carcinoma According to Basal Calcitonin Level

Andreas Machens MD*, Ulrich Schneyer MD, Hans-Jürgen Holzhausen MD, and Henning Dralle MD

Departments of General, Visceral and Vascular Surgery, Internal Medicine, Division of Endocrinology, and Pathology, Martin-Luther-University; Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale

* To whom correspondence should be addressed. E-mail: gensurg{at}medizin.uni-halle.de.

Prediction of remission in medullary thyroid carcinoma (MTC) depends on histopathologic information often unavailable before surgery. Simply requiring a venous blood sample, preoperative basal calcitonin levels may be a better indicator of remission.

In this institutional series of 224 consecutive patients with MTC and raised preoperative basal calcitonin, postoperative calcitonin levels normalized in 28 (62%) of 45 patients with node-negative MTC, and 18 (10%) of 177 patients with node-positive MTC. On multivariate analysis, preoperative basal calcitonin levels above 500 pg/mL predicted best the failure to achieve biochemical remission, followed by nodal metastasis and reoperative status. Cumulative rates of biochemical remission fell continuously with rising serum basal calcitonin in node-negative patients. Node-positive patients attained no longer biochemical remission when their preoperative basal calcitonin levels exceeded 3000 pg/mL. Nodal metastasis started emerging at basal calcitonin levels of 10 - 40 pg/mL (normal range: <10 pg/mL). Distant metastasis and extrathyroidal growth began appearing in patients with node-positive MTC at basal calcitonin levels of 150 - 400 pg/mL. There were no differences between patients with sporadic and hereditary MTC after adjusting for multiple testing.

Preoperative basal calcitonin levels may thus help individualize the extent of surgery and postoperative follow-up intervals for MTC.
Key words: Basal and Stimulated Calcitonin • Primary Tumor Diameter • Cumulative Risk • Extrathyroidal Growth • Nodal Metastasis • Distant Metastasis




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