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Determination of calcitonin levels in C-cell disease: clinical interest and potential pitfalls

Nature Clinical Practice Endocrinology & Metabolism volume 5, pages 35–44 (2009)Cite this article

Abstract

An elevated serum calcitonin level is a highly sensitive marker for medullary thyroid carcinoma (MTC) that can be used for screening, differential diagnosis, prognostic assessment, follow-up monitoring, and assessment of treatment response. Nevertheless, additional data are required to definitively support routine measurement of calcitonin levels in the initial work-up of patients with thyroid nodules, mainly because there is no convincing evidence that such testing actually reduces MTC-related mortality. By contrast, the prognostic value of measuring calcitonin levels preoperatively, postoperatively, and during follow-up of patients with MTC is widely acknowledged. Furthermore, determination of calcitonin levels is also used to evaluate the response of MTC to novel forms of systemic treatment, such as tyrosine kinase inhibitors. In this Review, we discuss the key issues surrounding the use of this laboratory test in the clinical management of patients with MTC.

Key Points

  • Serum calcitonin is a highly sensitive marker for medullary thyroid cancer

  • More evidence is necessary before routine calcitonin screening can be recommended in the initial management of thyroid nodular disease

  • Calcitonin screening for detection of medullary thyroid cancer in patients with thyroid nodules requires the availability of provocative tests (i.e. pentagastrin stimulation)

  • Calcitonin measurement can be used as a prognostic marker in postoperative follow-up of patients with medullary thyroid cancer

  • Determination of the calcitonin level is widely used to assess the efficacy of systemic treatment

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Figure 1: Preoperative calcitonin levels in patients with either C-cell hyperplasia or medullary thyroid carcinoma.
Figure 2: Correlation between serum calcitonin levels and disease progression.

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Acknowledgements

The work of S Filetti is supported by grants from the Italian Ministry of Universities and Research (PRIN), the Fondazione Umberto Di Mario ONLUS and the Banca d'Italia.

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Authors and Affiliations

  1. G Costante is an Assistant Professor at the University “Magna Graecia”, Catanzaro, Italy,

    Giuseppe Costante

  2. C Durante is a Postdoctoral Fellow and S Filetti is a Professor of Internal Medicine and Chairman of the Department of Internal Medicine at the University “Sapienza”, Rome, Italy.,

    Cosimo Durante & Sebastiano Filetti

  3. Z Francis is a Resident in the Department of Nuclear Medicine and Endocrine Oncology at the Institut Gustave Roussy, Villejuif, France.,

    Zélia Francis

  4. Paris and Chairman of the Department of Nuclear Medicine and Endocrine Oncology, M Schlumberger is a Professor of Oncology at the University Paris-Sud 11, Institut Gustave Roussy, Villejuif, France.,

    Martin Schlumberger

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  1. Giuseppe Costante
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Correspondence to Sebastiano Filetti.

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Costante, G., Durante, C., Francis, Z. et al. Determination of calcitonin levels in C-cell disease: clinical interest and potential pitfalls. Nat Rev Endocrinol 5, 35–44 (2009). https://doi.org/10.1038/ncpendmet1023

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