Karanikas Georgios, Moameni Abbas, Poetzi Christian, Zettinig Georg, Kaserer Klaus, Bieglmayer Christian, Niederle Bruno, Dudczak Robert, Pirich Christian
Department of Nuclear Medicin, University of Vienna, A-1090 Vienna, Austria.
J Clin Endocrinol Metab. 2004 Feb;89(2):515-9. doi: 10.1210/jc.2003-030709.
Routine measurement of serum calcitonin (CT) has been recently proposed for all patients with neoplastic thyroid disease to detect clinically occult medullary thyroid carcinoma (MTC). Data on the prevalence of elevated CT levels in nonneoplastic thyroid disease or in healthy subjects have not been reported to date. Four hundred and fourteen consecutive patients with suspected thyroid disease and 362 healthy controls underwent thyroid examination with measurement of basal serum CT. Whenever serum CT was 10 pg/ml or more, a pentagastrin (PG) stimulation test was performed. Twenty-eight of 414 patients (6.8%) showed elevated basal serum CT levels, 15 of them with nonneoplastic thyroid disease, and the remaining 13 subjects with neoplastic thyroid disease. Four patients with abnormal PG testing (stimulated CT, > or = 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).
最近有人提议对所有患有甲状腺肿瘤性疾病的患者进行血清降钙素（CT）的常规检测，以发现临床上隐匿的甲状腺髓样癌（MTC）。迄今为止，尚未有关于非肿瘤性甲状腺疾病或健康受试者中CT水平升高患病率的数据报道。414例连续的疑似甲状腺疾病患者和362例健康对照者接受了甲状腺检查，并检测了基础血清CT。每当血清CT≥10 pg/ml时，就进行五肽胃泌素（PG）刺激试验。414例患者中有28例（6.8%）基础血清CT水平升高，其中15例患有非肿瘤性甲状腺疾病，其余13例患有肿瘤性甲状腺疾病。确定了4例PG检测异常（刺激后CT≥100 pg/ml）的患者。其中3例有甲状腺炎的生化和超声证据。桥本甲状腺炎（HT）患者基础CT水平升高明显更常见（P<0.05）。1例HT女性患者有一个5 mm的结节，被分类为MTC。362例基础CT升高的健康对照者中有6例（1.7%），均未出现PG试验异常。我们的数据表明，基础CT检测不仅可用于检测/筛查患有肿瘤性甲状腺疾病的受试者中的MTC，也可用于有HT免疫学证据的患者。这些数据还证实了早期报告中关于PG刺激试验的重要价值，即使基础血浆CT水平仅轻度升高，对于确立MTC或其癌前相关疾病（微小MTC和肿瘤性C细胞增生）的诊断也是如此。
