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Kalzitoninbestimmung zur Frühdiagnose des medullären Schilddrüsenkarzinoms

Calcitonin determination for early diagnosis of medullary thyroid cancer

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Zusammenfassung

Kalzitonin ist ein sensitiver Marker für das medulläre Schilddrüsenkarzinom (MTC). Durch frühe Erkennung und chirurgische Therapie kann die Prognose des MTC verbessert werden. In der diagnostischen Evaluation von Schilddrüsenknoten wird daher die routinemäßige Kalzitoninbestimmung empfohlen. Bei einem erhöhten basalen Serumkalzitonin (>20 pg/ml) ist ein Bestätigungstest sinnvoll, um den positiven Vorhersagewert für ein MTC insbesondere bei kleinen Tumoren zu erhöhen. Eine definitive Unterscheidung von Mikro-MTC (<10 mm) und C-Zell-Hyperplasie ist anhand des Serumkalzitonins nicht möglich. Stimulierte Kalzitoninwerte von >100 pg/ml werden aufgrund des hohen Karzinomrisikos als Indikation zur Thyreoidektomie angesehen. Der Nachweis eines sehr hohen basalen und stimulierten Kalzitonins ist praktisch beweisend für ein MTC, mit praktischen Konsequenzen für die Operationsplanung.

Abstract

Calcitonin is considered to be a sensitive marker for medullary thyroid cancer (MTC) therefore early detection and surgical treatment may help to improve the clinical prognosis of MTC. Routine calcitonin measurement has therefore been recommended in the diagnostic evaluation of patients with nodular thyroid disease. In the case of elevated serum calcitonin (>20 pg/ml) stimulation testing is recommended to improve the predictive power for MTC particularly in patients with small nodules. Serum calcitonin measurement cannot reliably discriminate between micro-MTC (<10 mm) and C cell hyperplasia. In patients with stimulated calcitonin levels exceeding 100 pg/ml thyroidectomy is recommended because of a high inherent risk of MTC. Highly elevated basal and stimulated serum calcitonin levels are strongly suggestive of MTC with practical implications for surgical management.

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  1. Sektion Endokrinologie und Diabetologie - Medizinische Klinik III, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    W. Karges

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Karges, W. Kalzitoninbestimmung zur Frühdiagnose des medullären Schilddrüsenkarzinoms. Chirurg 81, 620–626 (2010). https://doi.org/10.1007/s00104-009-1883-9

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