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Gild ML, Clifton-Bligh RJ, Wirth LJ, Robinson BG. Medullary Thyroid Cancer: Updates and Challenges. Endocr Rev 2023; 44:934-946. [PMID: 37204852 PMCID: PMC10656709 DOI: 10.1210/endrev/bnad013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/19/2023] [Accepted: 05/18/2023] [Indexed: 05/20/2023]
Abstract
A personalized approach to the management of medullary thyroid cancer (MTC) presents several challenges; however, in the past decade significant progress has been made in both diagnostic and treatment modalities. Germline rearranged in transfection (RET) testing in multiple endocrine neoplasia 2 and 3, and somatic RET testing in sporadic MTC have revolutionized the treatment options available to patients. Positron emission tomography imaging with novel radioligands has improved characterization of disease and a new international grading system can predict prognosis. Systemic therapy for persistent and metastatic disease has evolved significantly with targeted kinase therapy especially for those harboring germline or somatic RET variants. Selpercatinib and pralsetinib are highly selective RET kinase inhibitors that have shown improved progression-free survival with better tolerability than outcomes seen in earlier multikinase inhibitor studies. Here we discuss changes in paradigms for MTC patients: from determining RET alteration status upfront to novel techniques for the evaluation of this heterogenous disease. Successes and challenges with kinase inhibitor use will illustrate how managing this rare malignancy continues to evolve.
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Affiliation(s)
- Matti L Gild
- Faculty of Health and Medicine, University of Sydney, Sydney 2006, Australia
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney 2065, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney 2065, Australia
| | - Roderick J Clifton-Bligh
- Faculty of Health and Medicine, University of Sydney, Sydney 2006, Australia
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney 2065, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney 2065, Australia
| | - Lori J Wirth
- Department of Medicine, Massachusetts General Hospital, & Harvard Medical School, Boston 02114, USA
| | - Bruce G Robinson
- Faculty of Health and Medicine, University of Sydney, Sydney 2006, Australia
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney 2065, Australia
- Cancer Genetics, Kolling Institute of Medical Research, Sydney 2065, Australia
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2
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Filipović B, Ajdžanović V, Živanović J, Trifunović S, Ristić N, Milošević V, Šošić-Jurjević B. Age-Related Changes in Calcitonin-Producing Thyroid C-Cells of Male Wistar Rats. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2022; 28:1-9. [PMID: 35592886 DOI: 10.1017/s1431927622000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Thyroid C-cells secrete the hormone calcitonin (CT) which acts as an inhibitor of bone resorption. Our aim was to examine the age-related changes in the structure and function of CT-producing C-cells, using histomorphometric, ultrastructural, and biochemical analyses. We used young adult (3-months-old), middle-aged (16-months-old), and old (24-months-old) male rats. The peroxidase-antiperoxidase method was applied for localization of CT. Stereological analysis was performed using the newCAST stereological software package. Serum samples were analyzed for the determination of CT, testosterone (T), calcium (Ca2+), and phosphorus (P). We found a significant increase in the volume density (Vv) of C-cells in both older groups (p < 0.05). The percentage of smaller volume range C-cells increased (p < 0.0001), while the proportion of greater volume range C-cells decreased (p < 0.05) with ageing. Ultrastructural analysis revealed a larger number of secretory granules in older rats. Serum CT increased (p < 0.001), while serum T and P were reduced (p < 0.01) in older rats. Serum Ca2+ was lower (p < 0.0001) in middle-aged rats compared to young adults. We revealed a 20% incidence of C-cell hyperplasia in older rats and one case of medullary thyroid carcinoma in an old rat. Our findings indicate that the ageing process causes significant histomorphometric changes at the thyroid C-cell level.
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Affiliation(s)
- Branko Filipović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd., 11060 Belgrade, Serbia
| | - Vladimir Ajdžanović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd., 11060 Belgrade, Serbia
| | - Jasmina Živanović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd., 11060 Belgrade, Serbia
| | - Svetlana Trifunović
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd., 11060 Belgrade, Serbia
| | - Nataša Ristić
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd., 11060 Belgrade, Serbia
| | - Verica Milošević
- Department of Anatomy, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Branka Šošić-Jurjević
- Department of Cytology, Institute for Biological Research "Siniša Stanković" - National Institute of the Republic of Serbia, University of Belgrade, 142 Despot Stefan Blvd., 11060 Belgrade, Serbia
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3
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Benvenga S, Micali A, Ieni A, Antonelli A, Fallahi P, Pallio G, Irrera N, Squadrito F, Picciolo G, Puzzolo D, Minutoli L. The Association of Myo-Inositol and Selenium Contrasts Cadmium-Induced Thyroid C Cell Hyperplasia and Hypertrophy in Mice. Front Endocrinol (Lausanne) 2021; 12:608697. [PMID: 33716965 PMCID: PMC7949001 DOI: 10.3389/fendo.2021.608697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
Previous studies have demonstrated that, in addition to inducing structural changes in thyroid follicles, cadmium (Cd) increased the number of C cells. We examined the effects of myo-inositol (MI), seleno-L-methionine (Se), MI + Se, and resveratrol on C cells of mice exposed to cadmium chloride (Cd Cl2), as no data are currently available on the possible protective effects of these molecules. In contrast, we have previously shown this protective effect against CdCl2 on the thyroid follicles of mice. Ninety-eight C57 BL/6J adult male mice were divided into 14 groups of seven mice each: (i) 0.9% NaCl (vehicle; 1 ml/kg/day i.p.); (ii) Se (0.2 mg/kg/day per os); (iii) Se (0.4 mg/kg/day per os); (iv) MI (360 mg/kg/day per os); (v) Se (0.2 mg/kg/day) + MI; (vi) Se (0.4 mg/kg/day) + MI; (vii) resveratrol (20 mg/kg); (viii) CdCl2 (2 mg/kg/day i.p.) + vehicle; (ix) CdCl2 + Se (0.2 mg/kg/day); (x) CdCl2 + Se (0.4 mg/kg/day); (xi) CdCl2 + MI; (xii) CdCl2 + Se (0.2 mg/kg/day) + MI; (xiii) CdCl2 + Se (0.4 mg/kg/day) + MI; (xiv) CdCl2 + resveratrol (20 mg/kg). After 14 days, thyroids were processed for histological, immunohistochemical, and morphometric evaluation. Compared to vehicle, Cd significantly decreased follicle mean diameter, increased CT-positive cells number, area and cytoplasmic density, and caused the disappearance of TUNEL-positive C cells, namely, the disappearance of C cells undergoing apoptosis. Se at either 0.2 or 0.4 mg/kg/day failed to significantly increase follicular mean diameter, mildly decreased CT-positive cells number, area and cytoplasmic density, and was ineffective on TUNEL-positive C cells. Instead, MI alone increased significantly follicular mean diameter and TUNEL-positive cells number, and decreased significantly CT-positive cells number, area and cytoplasmic density. MI + Se 0.2 mg/kg/day or MI + Se 0.4 mg/kg/day administration improved all five indices more markedly. Indeed, follicular mean diameter and TUNEL-positive cells number increased significantly, while CT-positive cells number, area and cytoplasmic density decreased significantly. Thus, all five indices overlapped those observed in vehicle-treated mice. Resveratrol improved significantly all the considered parameters, with a magnitude comparable to that of MI alone. In conclusion, the association Myo + Se is effective in protecting the mouse thyroid from the Cd-induced hyperplasia and hypertrophy of C cells. This benefit adds to that exerted by Myo + Se on thyrocytes and testis.
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Correspondence: Giovanni Pallio,
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giacomo Picciolo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Domenico Puzzolo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Letteria Minutoli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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4
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Abstract
C cell hyperplasia is considered a precursor lesion for hereditary forms of medullary thyroid carcinoma. It has therefore been suggested as a morphological marker to distinguish hereditary from sporadic medullary thyroid carcinoma and to triage genetic testing in resource poor settings. However, numerous definitions for C cell hyperplasia have been suggested, and there is surprisingly little data regarding the number of C cells present in thyroid glands removed for conditions other than medullary carcinoma. We therefore sought to investigate the specificity of different criteria for C cell hyperplasia. We examined the number of C cells and solid cell nests (ultimobranchial body remnants) present in 118 completion thyroidectomy specimens from patients without medullary carcinoma and with no risk factors for MEN2. Morphological review was performed on all H&E-stained slides, and immunohistochemistry for calcitonin was performed on one block from each case. Solid cell nests were found in 4 (3.3%) of thyroids. Increased numbers of C cells sufficient to fulfil criteria for C cell hyperplasia were found in 5 (4.2%) to 36 (30.5%) cases depending on the criteria used. We conclude that large numbers of C cells are commonly found in thyroids not associated with medullary carcinoma. Therefore, regardless of which criteria are used, the presence of C cell hyperplasia is not a specific marker for hereditary medullary thyroid carcinoma.
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Affiliation(s)
- Talia L Fuchs
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW, 2065, Australia
| | - Stephen E Bell
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
| | - A Chou
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW, 2065, Australia
- University of Sydney, Sydney, NSW, 2006, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia.
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW, 2065, Australia.
- University of Sydney, Sydney, NSW, 2006, Australia.
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5
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Guilmette J, Nosé V. Hereditary and familial thyroid tumours. Histopathology 2017; 72:70-81. [DOI: 10.1111/his.13373] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 01/16/2023]
Affiliation(s)
| | - Vania Nosé
- Massachusetts General Hospital; Boston MA USA
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6
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Kahaly GJ, Algeciras-Schimnich A, Davis TE, Diana T, Feldkamp J, Karger S, König J, Lupo MA, Raue F, Ringel MD, Sipos JA, Kratzsch J. United States and European Multicenter Prospective Study for the Analytical Performance and Clinical Validation of a Novel Sensitive Fully Automated Immunoassay for Calcitonin. Clin Chem 2017; 63:1489-1496. [DOI: 10.1373/clinchem.2016.270009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/10/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The objective of this study is the validation and proof of clinical relevance of a novel electrochemiluminescence immunoassay (ECLIA) for the determination of serum calcitonin (CT) in patients with medullary thyroid carcinoma (MTC) and in different diseases of the thyroid and of calcium homeostasis.
METHODS
This was a multicenter prospective study on basal serum CT concentrations performed in 9 US and European referral institutions. In addition, stimulated CT concentrations were measured in 50 healthy volunteers after intravenous calcium administration (2.5 mg/kg bodyweight).
RESULTS
In total, 1929 patients and healthy controls were included. Limits of blank, detection, and quantification for the ECLIA were 0.3, 0.5, and 1 ng/L, respectively. Highest intra- and interassay coefficients of variation were 7.4% (CT concentration, 0.8 ng/L) and 7.0% (1.1 ng/L), respectively. Medians (interval) of serum CT concentrations in 783 healthy controls were 0.8 ng/L (<0.5–12.7) and 3 ng/L (<0.5–18) for females and males, respectively (97.5th percentile, 6.8 and 11.6 ng/L, respectively). Diagnostic sensitivity and specificity were 100%/97.1% and 96.2%/96.4%, for female/males, respectively. Patients (male/female) with primary hyperparathyroidism, renal failure, and neuroendocrine tumors showed CT concentrations >97.5th percentile in 33%/4.7%, 18.5%/10%, and 8.3%/12%, females/males, respectively. Peak serum CT concentrations were reached 2 min after calcium administration (161.7 and 111.8 ng/L in males and females, respectively; P < 0.001).
CONCLUSIONS
Excellent analytical performance, low interindividual variability, and low impact of confounders for increased CT concentrations in non-MTC patients indicate that the investigated assay has appropriate clinical utility. Calcium-stimulated CT results suggest good test applicability owing to low interindividual variability.
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Affiliation(s)
- George J Kahaly
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | - Tanja Diana
- Molecular Thyroid Research Laboratory, Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | - Stefan Karger
- Clinic for Endocrinology and Nephrology, Leipzig University, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, JGU Medical Center, Mainz, Germany
| | - Mark A Lupo
- Thyroid & Endocrine Center of Florida, Sarasota, FL
| | | | - Matthew D Ringel
- The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, OH
| | - Jennifer A Sipos
- The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, OH
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7
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Nasikas DK, Sofopoulos M, Arnogiannaki N, Sakorafas GH. C-cell hyperplasia as an incidental finding in a patient with papillary thyroid microcarcinoma. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
C-cell hyperplasia (CCH) is considered as a preneoplastic lesion associated with various endocrinopathies. Traditionally it is subdivided into reactive (benign) CCH and neoplastic. We report here a case of a young male, where CCH was an incidental finding after total thyroidectomy for papillary thyroid cancer.
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Affiliation(s)
- Dimitrios K Nasikas
- Department of Surgery, Saint Savvas Cancer Hospital, Arkadias 19–21, 115 26, Athens, Greece
| | - Michael Sofopoulos
- Department of Pathology, Saint Savvas Cancer Hospital, Arkadias 19–21, 115 26, Athens, Greece
| | - Niki Arnogiannaki
- Department of Pathology, Saint Savvas Cancer Hospital, Arkadias 19–21, 115 26, Athens, Greece
| | - George H Sakorafas
- Department of Surgery, Saint Savvas Cancer Hospital, Arkadias 19–21, 115 26, Athens, Greece
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8
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Sakorafas GH, Nasikas D, Thanos D, Gantzoulas S. Incidental thyroid C cell hyperplasia: clinical significance and implications in practice. Oncol Res Treat 2015; 38:249-52. [PMID: 25966772 DOI: 10.1159/000381605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/03/2015] [Indexed: 11/19/2022]
Abstract
Incidental C cell hyperplasia (CCH) following thyroidectomy for other indications may rarely be encountered, which may raise concerns about its clinical significance and proper management. CCH can be classified as physiological (reactive) or neoplastic. Reactive CCH has no malignant potential and can be observed in association with many other thyroid diseases (including differentiated thyroid cancer); in contrast, neoplastic CCH should be considered as a preneoplastic stage in the spectrum of C cell disease, ultimately leading to the development of medullary thyroid cancer (MTC). Neoplastic CCH is commonly observed in patients with germ-line mutations in the RET oncogene (commonly in families with a history of hereditary MTC, i.e. familial MTC or multiple endocrine neoplasia type 2 (MEN2)). CCH should be considered in patients with hypercalcitoninemia without nodular thyroidopathy. Total thyroidectomy, which is commonly performed for the majority of thyroid diseases, is an adequate treatment and achieves cure, even in patients with neoplastic CCH. There is no role for cervical lymph node dissection in patients with pure CCH. In conclusion, reactive CCH has no malignant potential, in contrast to neoplastic CCH. Total thyroidectomy achieves cure of patients with CCH.
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Affiliation(s)
- George H Sakorafas
- Department of Surgical Oncology, SAINT SAVVAS Cancer Hospital, Athens, Greece
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9
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Zayed AA, Ali MKM, Jaber OI, Suleiman MJ, Ashhab AA, Al Shweiat WM, Momani MS, Shomaf M, AbuRuz SM. Is Hashimoto's thyroiditis a risk factor for medullary thyroid carcinoma? Our experience and a literature review. Endocrine 2015; 48:629-36. [PMID: 25056007 DOI: 10.1007/s12020-014-0363-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/08/2014] [Indexed: 11/24/2022]
Abstract
The etiology of medullary thyroid carcinoma remains unknown. The aim of this study was to determine whether there is a significant association between medullary thyroid carcinoma and Hashimoto's thyroiditis in the histopathologic material of thyroidectomized patients. Retrospective cross-sectional study. In this study, we reviewed the medical records of all patients who underwent total thyroidectomy for different thyroid-related complaints between January 2000 and January 2012 at Jordan University Hospital-Amman, Jordan. To highlight relevant previously published studies addressing this topic, a literature search was conducted for English language studies reporting "medullary thyroid carcinoma" or "C-cell hyperplasia" in patients with Hashimoto's thyroiditis. Of the 863 patients with a mean age of 47.2 ± 12.3 years who underwent total thyroidectomy during the study period, 78 (9.04 %) were diagnosed with Hashimoto's thyroiditis, and 15 (1.74 %) had medullary thyroid carcinoma, 3 (20 %) of whom had coexistent Hashimoto's thyroiditis. A total of 683 (79.1 %) patients had benign thyroid disease, 67 (9.8 %) of whom had Hashimoto's thyroiditis. The difference between these rates was not statistically significant (p = 0.19). When examined by gender, 9 females had medullary thyroid carcinoma, 3 (33.3 %) of whom had coexistent Hashimoto's thyroiditis; by contrast, of 560 females with benign thyroid disease, 62 (11.1 %) had Hashimoto's thyroiditis (p = 0.04). Although this study population represents a small and single-institution experience, our results suggest that there might be an association between Hashimoto's thyroiditis and medullary thyroid carcinoma only in female patients who undergo total thyroidectomy.
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Affiliation(s)
- Ayman A Zayed
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The University of Jordan/Jordan University Hospital, P.O Box 13046, Amman, 11942, Jordan,
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10
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d'Herbomez M, Bauters C, Cortet-Rudelli C, Dewailly D, Docao C, Wémeau JL. [Biomarkers in endocrinology]. Presse Med 2013; 43:40-56. [PMID: 24342177 DOI: 10.1016/j.lpm.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/12/2013] [Indexed: 10/25/2022] Open
Abstract
TSH assay is the best parameter of the thyroid function. For adults, the normal interval of TSH concentrations range from 0.4 to 4 mUI/L. At the first trimester of pregnancy, TSH levels must be <2.5 mUI/L. Normal TSH levels increase with aging and obesity. The biological diagnosis relies on the identification of excessive secretion of the metanephrines which are more sensitive and specific than those of catecholamines. The concentrations of the free plasmatic metanephrines reflect the ongoing production of tumor. Plasma methoxytyramine is a novel biomarker of metastatic pheochromocytomas and paragangliomas. Serum IGF1 is a reliable measure of integrated GH concentrations in patients with acromegaly. Accurate assessment of IGF1 concentrations requires age and sex-matched control values. IGF1 is a sensitive tool for the diagnosis of acromegaly and efficacy of therapies. Serum AMH assay is more sensitive, more specific and more reproducible that counting of ovarian follicles by ultrasound. AMH level above 5 ng/mL (35 pmol/L) could be chosen as one of the diagnostic criteria for the polycystic ovary syndrome. In early or "incipiens" ovarian failure, the decrease in serum AMH is far ahead of the increase in FSH. Thyroglobulin (TG) and calcitonin (CT) are the sensitive and specific markers of respectively well-differentiated thyroid cancers of follicular origin and of the medullary thyroid cancers. The same tumour marker assay should be used to monitor a given patient. Chromogranin A (CgA) is a highly efficient biomarker for diagnosis and follow-up of various endocrine tumours. Despite the lack of international standardisation, some CgA assays are reliable.
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Affiliation(s)
- Michèle d'Herbomez
- Université de Lille II, 59800 Lille, France; CHRU de Lille, centre de biologie-pathologie-génétique, rue Émile-Laine, 59037 Lille cedex, France.
| | - Catherine Bauters
- Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| | | | - Didier Dewailly
- Université de Lille II, 59800 Lille, France; Hôpital Jeanne-de-Flandre, service de gynécologie endocrinienne et médecine de la reproduction, 59037 Lille cedex, France
| | - Christine Docao
- Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
| | - Jean-Louis Wémeau
- Université de Lille II, 59800 Lille, France; Clinique d'endocrinologie Marc-Linquette, hôpital Huriez, 59037 Lille cedex, France
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11
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Abstract
Medullary thyroid carcinoma (MTC) is rare in children. MTC is almost always inherited and occurs as part of a multiple endocrine neoplasia type 2A and B, due to germline mutation in the RET proto-oncogene. MTC in the pediatric population is most often diagnosed in the course of a familial genetic investigation. But when the child is the proband, a de novo mutation is most often founded. The main aim is to treat MTC before extrathyroidal extension occurs because when distant metastases are present, it is rarely curable. Treatment is based on total thyroidectomy with cervical lymph node dissection.
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12
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Nicolau Ramis J, Masmiquel Comas L. [The new antidiabetic agents in the firing line.... safety reasons or witch hunt?]. ACTA ACUST UNITED AC 2011; 59:1-8. [PMID: 22177885 DOI: 10.1016/j.endonu.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 11/21/2011] [Indexed: 02/06/2023]
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13
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d'Herbomez M. [Calcitonin: indications and interpretation]. Presse Med 2011; 40:1141-6. [PMID: 22035862 DOI: 10.1016/j.lpm.2011.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/17/2011] [Accepted: 05/20/2011] [Indexed: 10/15/2022] Open
Abstract
Calcitonin is the sensitive and specific marker of the medullary thyroid cancers. It is a diagnostic, pronostic and follow-up marker. Medullary thyroid cancer is a rare disease representing 4% of the thyroid cancers and occurring in 0.4% of nodular thyroid pathology. The use of sex specific adults normal ranges allows a better interpretation of the moderately elevated calcitonin levels. Hypercalcitoninaemia non due to medullary thyroid cancer are attributed mainly to male sex, tobacco use, overweight, renal failure and other endocrine tumors. CT is associated to carcinoembryonic antigen and possible procalcitonin assays. Calcitonin can be assayed in the wash-out fluid of the fine needle aspiration too. Stimulation tests give poor additional diagnostic information and are about to be abandoned.
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14
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Wémeau JL, Sadoul JL, d'Herbomez M, Monpeyssen H, Tramalloni J, Leteurtre E, Borson-Chazot F, Caron P, Carnaille B, Léger J, Do C, Klein M, Raingeard I, Desailloud R, Leenhardt L. Guidelines of the French society of endocrinology for the management of thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2011; 72:251-281. [PMID: 21782154 DOI: 10.1016/j.ando.2011.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 01/21/2023]
Abstract
The present document is a follow-up of the clinical practice guidelines of the French Society of Endocrinology, which were established for the use of its members and made available to scientific communities and physicians. Based on a critical analysis of data from the literature, consensuses and guidelines that have already been published internationally, it constitutes an update of the report on the diagnostic management of thyroid nodules that was proposed in France, in 1995, under the auspices of the French National Agency for Medical Evaluation (l'Agence nationale d'évaluation médicale). The current guidelines were deliberated beforehand by a number of physicians that are recognised for their expertise on the subject, coming from the specialities of endocrinology (the French Thyroid Research Group) and surgery (the French Association for Endocrine Surgery), as well as representatives from the fields of biology, ultrasonography, cytology and nuclear medicine. The guidelines were presented and submitted for the opinion of the members of the Society at its annual conference, which was held in Nice from 7-10 October 2009. The amended document was posted on the website of the Society and benefited from additional remarks of its members. The final version that is presented here was not subjected to methodological validation. It does not claim to be universal in its scope and will need to be revised in concert with progress made in technical and developmental concepts. It constitutes a document that the Society deems useful for distribution concerning the management of thyroid nodules, which is current, efficient and cost effective.
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Affiliation(s)
- J-L Wémeau
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France.
| | - J-L Sadoul
- Endocrinologie, hôpital de l'Archet, CHU 06202 Nice cedex, France
| | - M d'Herbomez
- Département de médecine nucléaire, centre de biologie pathologie, centre hospitalier régional, 59037 Lille cedex, France
| | - H Monpeyssen
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - J Tramalloni
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - E Leteurtre
- Inserm U560, service d'anatomie pathologique, CHRU de Lille, Lille, France
| | - F Borson-Chazot
- Hôpital Louis-Pradel, CHU des hospices civils de Lyon, 28, avenue Doyen-Lépine, 69500 Bron, France
| | - P Caron
- CHU Larrey, avenue du Jean-Poulhès, 31400 Toulouse, France
| | - B Carnaille
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - J Léger
- Service d'endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - C Do
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - M Klein
- Service d'endocrinologie, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - I Raingeard
- Service des maladies métaboliques et endrocriennes, hôpital Lapeyronie, 34295 Montpellier cedex 5, France
| | - R Desailloud
- Service d'endocrinologie, diabétologie et nutrition, hôpital Sud, CHU d'Amiens, avenue René-Laënnec, 80054 Amiens, France
| | - L Leenhardt
- Service de médecine nucléaire, hôpital Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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15
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Hegedüs L, Moses AC, Zdravkovic M, Le Thi T, Daniels GH. GLP-1 and calcitonin concentration in humans: lack of evidence of calcitonin release from sequential screening in over 5000 subjects with type 2 diabetes or nondiabetic obese subjects treated with the human GLP-1 analog, liraglutide. J Clin Endocrinol Metab 2011; 96:853-60. [PMID: 21209033 DOI: 10.1210/jc.2010-2318] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Serum calcitonin (CT) is a well-accepted marker of C-cell proliferation, particularly in medullary thyroid carcinoma. Chronic glucagon-like peptide-1 (GLP-1) receptor agonist administration in rodents has been associated with increased serum CT levels and C-cell tumor formation. There are no longitudinal studies measuring CT in humans without medullary thyroid carcinoma or a family history of medullary thyroid carcinoma and no published studies on the effect of GLP-1 receptor agonists on human serum CT concentrations. AIM The aim of the study was to determine serum CT response over time to the GLP-1 receptor agonist liraglutide in subjects with type 2 diabetes mellitus or nondiabetic obese subjects. METHODS Unstimulated serum CT concentrations were measured at 3-month intervals for no more than 2 yr in a series of trials in over 5000 subjects receiving liraglutide or control therapy. RESULTS Basal mean CT concentrations were at the low end of normal range in all treatment groups and remained low throughout the trials. At 2 yr, estimated geometric mean values were no greater than 1.0 ng/liter, well below upper normal ranges for males and females. Proportions of subjects whose CT levels increased above a clinically relevant cutoff of 20 ng/liter were very low in all groups. There was no consistent dose or time-dependent relationship and no consistent difference between treatment groups. CONCLUSIONS These data do not support an effect of GLP-1 receptor activation on serum CT levels in humans and suggest that findings previously reported in rodents may not apply to humans. However, the long-term consequences of GLP-1 receptor agonist treatment are a subject of further studies.
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Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
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16
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Cherenko M, Slotema E, Sebag F, De Micco C, Henry JF. Mild hypercalcitoninaemia and sporadic thyroid disease. Br J Surg 2010; 97:684-90. [DOI: 10.1002/bjs.6965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Not operating on patients with mild hypercalcitoninaemia (MHCT) and sporadic thyroid disease carries the risk of omitting curative surgery for medullary thyroid cancer, but systematic surgery would result in unnecessary treatment of benign pathology. This study reviewed the management of MCHT and non-hereditary thyroid disease in one centre.
Methods
MCHT was defined as an increase in basal and stimulated calcitonin levels not exceeding 30 and 200 pg/ml respectively. Over 15 years, 125 patients who presented with MCHT and sporadic thyroid disease were followed. Surgery was indicated only if there were local pressure symptoms or suspicious histomorphological changes in solitary nodules.
Results
Fifty-five patients underwent total thyroidectomy and 18 unilateral total lobectomy. Histological examination revealed medullary microcarcinoma in six patients (two women and four men). C-cell hyperplasia was found in 54 patients (74 per cent) and 13 (18 per cent) harboured no C-cell pathology. Calcitonin levels stabilized after lobectomy and became undetectable following thyroidectomy. They normalized during follow-up in a third of patients who did not have surgery.
Conclusion
Not all patients with MHCT and sporadic thyroid disease require surgery.
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Affiliation(s)
- M Cherenko
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
| | - E Slotema
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
| | - F Sebag
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
| | - C De Micco
- Department of Pathology, University Hospital Marseilles, Marseilles, France
| | - J F Henry
- Department of Endocrine Surgery, University Hospital Marseilles, Marseilles, France
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17
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Abstract
Thyroid and parathyroid diseases are fairly common and can be either hereditary or sporadic in nature. Tumors and tumor-like processes account for the majority of surgical pathology specimens in both of these endocrine organs. Molecular alterations are well known to occur in both the hereditary and the sporadic settings, and include alterations in tumor suppressor genes and oncogenes. The genetic pathways of tumors of parathyroid and thyroid are beginning to be well understood and are proving to be useful diagnostic, prognostic, and potential therapeutic targets. The molecular alterations in parathyroid and thyroid tumors and tumor-like processes are reviewed, with a focus on the potentially clinically useful diagnostic markers.
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18
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Moore SW, Zaahl MG. Multiple endocrine neoplasia syndromes, children, Hirschsprung's disease and RET. Pediatr Surg Int 2008; 24:521-30. [PMID: 18365214 DOI: 10.1007/s00383-008-2137-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2008] [Indexed: 01/20/2023]
Abstract
Multiple endocrine neoplasia (MEN) type 2 syndromes are autosomal dominant clinical associations characterized by a common clinical feature, medullary thyroid carcinoma (MTC). The ability to accurately predict the risk by genetic RET proto-oncogene analysis has resulted in the active follow-up of children at risk for developing early metastatic tumours and which can be prevented by prophylactic thyroidectomy. The C634 and M918T mutations (associated with MEN2A and MEN2B, respectively) are particularly associated with early aggressive behavior and distant metastatic spread requiring early intervention. RET is known to be involved in cellular signalling processes during development and controls the survival, proliferation, differentiation and migration of the enteric nervous system (ENS) progenitor cells, as well as the survival and regeneration of sympathetic neural and kidney cells. The centrality of RET in the etiology of both MEN2 and HSCR is now well established with fairly consistent associations existing between RET genotype and phenotype in MEN2. The relationship between Hirschsprung's disease (HSCR) MEN2 syndromes appears to be a highly significant one, sharing a common etiological factor in the RET proto-oncogene. It is now well accepted that most HSCR arises from loss of function, RET mutations, RET haploinsufficiency or RET polymorphisms and haplotypes of the RET promotor region. MEN2 syndromes result from gene up regulation due to germline activating mutations in the RET proto-oncogene (1:500,000). MTC is mostly associated with variations in the 5 cysteine RET radicals and codon-risk management protocols are of considerable value but not infallible. Oncogenic RET mutations may, however, vary between specific population groups. RET analysis in MEN has revolutionized the management of children of MEN2 and allowed surgical prediction and prophylaxis to take place. We discuss the role of genetic testing and possible guidelines for the management of patients from MTC families. The future appears full of promise and the current evaluation of RET-targeting tyrosine kinase and other inhibitors are of considerable interest in the management of these conditions.
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Affiliation(s)
- S W Moore
- Faculty of Health Sciences, University of Stellenbosch, 7505, Tygerberg, South Africa.
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19
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Saggiorato E, Rapa I, Garino F, Bussolati G, Orlandi F, Papotti M, Volante M. Absence of RET gene point mutations in sporadic thyroid C-cell hyperplasia. J Mol Diagn 2007; 9:214-9. [PMID: 17384213 PMCID: PMC1867441 DOI: 10.2353/jmoldx.2007.060166] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Progression from C-cell hyperplasia (CCH) to medullary thyroid carcinoma (MTC) has been demonstrated to date only in familial forms, whereas in nonfamilial MTC, such hypothesis is suggested by the rare concurrence of both lesions, although no epidemiological and molecular data are available to prove or disprove this event. Therefore, the clinical management of patients with sporadic CCH is controversial. To evaluate the malignant potential of sporadic CCHs, pure laser-microdissected C-cell populations of 24 CCH cases, either reactive or associated with nonfamilial MTC, were analyzed for MTC-associated protein neural cell adhesion molecule expression and RET point mutations in exons 10, 11, 15, and 16, by using immunohistochemistry and polymerase chain reaction-single-strand conformation polymorphism/heteroduplex electrophoresis/direct sequencing, respectively. No RET mutations were found in any of the 24 CCH cases, whereas M918T mutation was detected in three concomitant MTCs. Neural cell adhesion molecule was immunoreactive in the majority of CCH associated with MTC even in the absence of morphological atypia, but not in reactive forms. The absence of RET alterations in all cases of CCH examined supports the hypothesis that the development of MTC is independent of pre-existing CCH in the nonfamilial setting; thus, sporadic CCH should not be considered a risk factor for nonfamilial MTC.
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Affiliation(s)
- Enrico Saggiorato
- Section of Endocrinology, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy.
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20
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Vantyghem MC, Danel T, Marcelli-Tourvieille S, Moriau J, Leclerc L, Cardot-Bauters C, Docao C, Carnaille B, Wemeau JL, D'Herbomez M. Calcitonin levels do not decrease with weaning in chronic alcoholism. Thyroid 2007; 17:213-7. [PMID: 17381353 DOI: 10.1089/thy.2006.0216] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Alcohol might increase calcitonin but this assertion is mainly based on the acute effect of the drug in small animals and humans. The aim of this study was to investigate the effect of chronic alcoholic intoxication on plasma calcitonin (CT) levels. DESIGN 20 smoking male subjects admitted to be weaned from chronic daily alcohol consumption >100 g were included after informed consent. Blood was sampled upon admission (T0) and after 5 (T5) and 21 (T21) days of alcohol weaning to measure mean erythrocyte volume, gamma-glutamyltransferase (GGT), calcium, gastrin, and CT levels. The control group consisted of 30 male subjects with daily alcohol consumption <20 g. MAIN OUTCOME The characteristics of the alcohol group were as follows (mean +/- SD): age 41.2 +/- 13 years old; mean erythrocyte volume: 96.0 +/- 4.2 microm(3) (N: 85-95); calcium level: 94.7 +/- 3.7 mg/L (N: 85-105); gastrinemia: 59.3 +/- 14.9 ng/mL (N: <120). At T0 and T21, three alcoholic subjects had CT levels above 10 pg/mL, usually considered as the normal cut-off value. There was no correlation between CT and the different biochemical parameters at T0, T5, and T21. There was no difference between CT levels at the different stages in the alcohol group (T0: 6.4 +/- 3.6 pg/mL; T5: 6.5 +/- 5.3 pg/mL; T21: 8.4 +/- 5.6), although GGT significantly decreased with weaning duration (T0: 248 +/- 354 IU/L; T5: 211 +/- 290 IU/L; T21: 79 +/- 90 IU/L; ANOVA, p <0.05). But a significant difference was found between mean CT levels in the alcohol group and in the control group (3.1 +/- 0.7 pg/mL, p <0.0001). CONCLUSIONS This study suggests that mean CT levels of chronically alcoholic smoking male subjects are higher than those of an age- and sex-matched control group. However, most alcoholic patients exhibited CT levels <10 pg/mL. No decrease in CT levels was noted over a short period of alcohol weaning. As CT measurement is currently recommended in thyroid nodule assessment, this finding may be important to know how to decipher borderline values of CT.
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Affiliation(s)
- M C Vantyghem
- Endocrinology and Metabolism Department, Lille University Hospital, Lille Cedex, France.
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