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A Machens, Dpt. of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), D-06097, Germany
F Hoffmann, Dpt. of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
C Sekulla, Halle/Saale, Germany
H Dralle, Halle, Germany

Correspondence: Andreas Machens, Email: AndreasMachens{at}aol.com

Abstract

Men and women differ in thyroidal C-cell mass and calcitonin secretion. This difference may have implications for the definition of calcitonin thresholds to distinguish sporadic C-cell hyperplasia from occult medullary thyroid cancer. This retrospective study examined the hypothesis that gender-specific calcitonin thresholds predict occult medullary thyroid cancer more accurately among patients with increased basal calcitonin levels than unisex thresholds. Evaluated were 100 consecutive patients with occult sporadic C-cell disease no larger than 10 millimeters who were referred for increased basal calcitonin levels and underwent pentagastrin stimulation preoperatively at this institution. Altogether, gender-specific calcitonin thresholds predicted medullary thyroid cancer better than unisex thresholds. At lower (50 pg/mL basally; 500 pg/mL after stimulation) but not higher calcitonin serum levels, women revealed medullary thyroid cancer 4-8 times more often than men. Most discriminatory between C-cell hyperplasia and medullary thyroid cancer was a basal calcitonin threshold of 15 (corrected 20) pg/mL for women and 80 (corrected 100) pg/mL for men, based on the greatest accuracy at the lowest possible calcitonin level. The respective gender-specific stimulated peak calcitonin thresholds were 80 (corrected 100) pg/mL and 500 pg/mL. Corresponding positive predictive values for medullary thyroid cancer at these calcitonin thresholds were 89 and 90% for women, as opposed to 100% for men. To increase the positive predictive value for women to 100%, the respective calcitonin thresholds would have to be raised to 40 (corrected 50) pg/mL and 250 pg/mL. These findings indicate that gender-specific calcitonin thresholds predict sporadic occult medullary thyroid cancer better than unisex thresholds.