Storani María E, Bostico Silvana T, Subies Fabiana A, Musich Magdalena, Oneto Adriana
Hospital Central de San Isidro. Dr. Melchor ángel Posse, Argentina. E-mail:
Grupo Médico Libertador, Acasusso, Argentina.
Medicina (B Aires). 2019;79(4):271-275.
There is much controversy about the benefits of the use of serum calcitonin (CT) in the initial evaluation of patients with thyroid nodules. The objective of the study was to early identify medullary thyroid carcinoma (MTC) through the routine measurement of CT in thyroid nodular pathology in a large cohort of patients from Buenos Aires, Argentina. Consecutive patients with nodular thyroid disease (n=1017) were studied. CT was measured by chemiluminescence, normal value: up to 18 pg/ml in men and 12 pg/ml in women. In two patients, hypercalcitoninemia was confirmed in repeated measurements. Fine needle aspiration with CT measurement in the needle wash fluid identified MTC in nodules with citology abnormalities. The genetic study was positive in one patient (mutation exon 14, Val804Met, MTC familiar). The other presented a polymorphism (exon 13 L769L heterozygous - exon 15 S904S heterozygous). In both cases, CT was normalized 3 months after surgery and remained normal after 6 years of follow-up. The routine measurement of CT in thyroid nodular pathology was useful to detect two cases of MTC, one of them sporadic and the other familiar in this cohort. The prevalence of MTC was 0.2%.
关于在甲状腺结节患者的初始评估中使用血清降钙素（CT）的益处存在诸多争议。本研究的目的是通过对来自阿根廷布宜诺斯艾利斯的一大群患者的甲状腺结节病理进行CT常规测量来早期识别甲状腺髓样癌（MTC）。对连续的甲状腺结节疾病患者（n = 1017）进行了研究。通过化学发光法测量CT，正常值：男性高达18 pg/ml，女性高达12 pg/ml。在两名患者中，重复测量证实了高降钙素血症。在针吸冲洗液中进行CT测量的细针穿刺在细胞学异常的结节中发现了MTC。基因研究在一名患者中呈阳性（第14外显子突变，Val804Met，家族性MTC）。另一名患者表现出多态性（第13外显子L769L杂合子 - 第15外显子S904S杂合子）。在这两种情况下，术后3个月CT恢复正常，随访6年后仍保持正常。在该队列中，甲状腺结节病理中CT的常规测量有助于检测出两例MTC，其中一例为散发性，另一例为家族性。MTC的患病率为0.2%。
