Exp Clin Endocrinol Diabetes 2004; 112(1): 52-58
DOI: 10.1055/s-2004-815727

J. A. Barth Verlag in Georg Thieme Verlag Stuttgart · New York

Calcitonin Measurement to Detect Medullary Thyroid Carcinoma in Nodular Goiter: German Evidence-Based Consensus Recommendation

W. Karges 1 , H. Dralle 2 , F. Raue 3 , K. Mann 4 , C. Reiners 5 , M. Grussendorf 6 , M. Hüfner 7 , B. Niederle 8 , G. Brabant 9 , German Society for Endocrinology (DGE) - Thyroid Section
  • 1Department of Internal Medicine, University of Ulm, Ulm, Germany
  • 2Department of General Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
  • 3Endokrinologische Gemeinschaftspraxis, Heidelberg, Germany
  • 4Department of Internal Medicine, University of Essen, Essen, Germany
  • 5Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
  • 6Endokrinologische Praxis, Stuttgart, Germany
  • 7Department of Internal Medicine, University of Göttingen, Göttingen, Germany
  • 8Department of General Surgery, University of Vienna, Vienna, Austria
  • 9Department of Internal Medicine, MHH Medical School Hannover, Hannover, Germany
Further Information

Publication History

Received: March 11, 2003 First decision: May 23, 2003

Accepted: June 4, 2003

Publication Date:
03 February 2004 (online)


Serum calcitonin (CT) has become a very specific and sensitive marker for human medullary thyroid carcinoma (MTC), a neuroendocrine tumor affecting about 1 % of patients with nodular thyroid disease. MTC is characterized by early micrometastasis and a lack of curative non-surgical treatment, so that early diagnosis is desirable. Based on a systematic review of scientific evidence, we propose multidisciplinary consensus recommendations for the clinical use of CT in patients with nodular goiter.

To exclude MTC, serum CT should be determined in patients with nodular thyroid disease, using a two-site CT immunoassay. If basal serum CT exceeds 10 pg/ml, CT should be analysed by pentagastrin stimulation testing, after renal insufficiency and proton pump inhibitor medication have been ruled out. As the risk for MTC is higher than 50 % in patients with stimulated CT values > 100 pg/ml, thyroidectomy is advised in these individuals. If stimulated CT exceeds 200 pg/ml, thyroidectomy and lymphadenectomy is strongly recommended. Pentagastrin-stimulated CT values < 100 pg/ml are associated with a low risk of MTC, or very rarely, non-metastasizing micro-MTC (size < 10 mm). Therefore, regular clinical and biochemical follow-up is the preferred treatment in such patients, unless thyroid malignancy is suspected otherwise.


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PD Dr. med. Wolfram Karges

Department of Internal Medicine 1 · University of Ulm

Robert-Koch-Straße 8

89081 Ulm


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Email: wolfram.karges@medizin.uni-ulm.de