Tormey William P, Byrne Brendan, Hill Arnold D, Sherlock Mark, Thompson Christopher J
Beaumont Hospital, Dublin, Ireland -
University of Ulster, Coleraine, UK -
Minerva Endocrinol. 2017 Dec;42(4):306-310. doi: 10.23736/S0391-1977.17.02566-4. Epub 2017 Jan 13.
The European Thyroid Association recommends serum calcitonin measurement in thyroid nodule cases. In contrast, the American Thyroid Association is ambivalent. In this institution, thyroid nodules cases are subject to a multidisciplinary evaluation of the clinical history and examination, ultrasound and scintigraphy, CT scan and sometimes MRI scan, biochemistry and histopathology of biopsies. We report on the current use of plasma calcitonin measurements in the context of changing practice which has not included screening of all thyroid nodules.
Laboratory records were searched from the beginning of January 2010 to the end of April 2016 for all serum calcitonin measurements.
There were 44 patients (30 females, age range 31 to 87 years with median 57.5) and 14 males, age range 20 to 85 years with median 53.4 years) who had a serum calcitonin measured. Of these 33 patients did not have a detectable serum calcitonin. There were 3 patients who had an initial elevated serum calcitonin which became undetectable over time. Over the same time period, a total of 2070 patients presented with thyroid nodules. Medullary thyroid cancer (MTC) was found in 7 cases. Thus assuming all MTC cases had calcitonin measured, MTC is 7 of 341 (2.05%) of the total thyroid cancer burden at the hospital and 7 of 2070 (0.338%) of all thyroid nodules. Our practice is not to routine screen all nodules for MTC.
Because patients with a nodule are subjected to ultrasound scanning and biopsy, when the nodule size is greater than 5 cm or when there is a modifying ultrasound or clinical characteristic, the consensus at the multidisciplinary conference on thyroids rather than universal calcitonin screening of all nodules is the better option in our judgement.
欧洲甲状腺协会建议对甲状腺结节病例进行血清降钙素检测。相比之下，美国甲状腺协会则态度模糊。在本机构，甲状腺结节病例需接受多学科评估，包括临床病史与检查、超声和闪烁扫描、CT扫描，有时还包括MRI扫描、活检的生物化学和组织病理学检查。我们报告了在不断变化的实践背景下血浆降钙素检测的当前应用情况，这种实践并不包括对所有甲状腺结节进行筛查。
检索2010年1月1日至2016年4月30日期间所有血清降钙素检测的实验室记录。
共有44例患者（30例女性，年龄范围31至87岁，中位数为57.5岁；14例男性，年龄范围20至85岁，中位数为53.4岁）进行了血清降钙素检测。其中33例患者的血清降钙素检测不到。有3例患者最初血清降钙素升高，但随时间推移变得检测不到。在同一时期，共有2070例患者出现甲状腺结节。发现7例甲状腺髓样癌（MTC）。因此，假设所有MTC病例都进行了降钙素检测，MTC占医院甲状腺癌总负担的341例中的7例（2.05%），占所有甲状腺结节的2070例中的7例（0.338%）。我们的做法是不对所有结节进行MTC的常规筛查。
由于有结节的患者会接受超声扫描和活检，当结节大小大于5cm或存在超声或临床特征改变时，在我们看来，甲状腺多学科会议上的共识而非对所有结节进行普遍的降钙素筛查是更好的选择。
