Appropriate and mindful measurement of serum calcitonin in patients with thyroid nodules. A white paper.

Medullary thyroid carcinoma (MTC) is an infrequent thyroid malignancy that is often diagnosed at advanced stage with consequent poor prognosis. Thus, the earlier the diagnosis of MTC, the better the prognosis. Unfortunately, the preoperative detection of MTC remains challenging in clinical practice. In fact, while ultrasound and fine-needle aspiration cytology have suboptimal performance in this context, measuring serum calcitonin (Ctn), fully recognized as the most reliable test to detect MTC, is not universally accepted as routine test in all patients with thyroid nodule(s). The authors of this paper reappraise critically the matter of Ctn measurement in view of the recent advancements in the literature to point out the essential information to be known, and then to prepare an easy-to-use guide for clinicians to appropriately consider the measurement of serum Ctn during clinical practice.

[Thyroid Elastography]. / Schilddrüsen-Elastografie.

Thyroid nodules are a common finding especially in regions with inadequate iodine supply. Ultrasound is an accurate method for the detection of thyroid nodules, but it has a low accuracy for the differentiation between benign and malignant thyroid nodules. Therefore, in patients with normal thyroid stimulating hormone fine-needle-aspiration-biopsy (FNAB) is presently recommended as supplementary diagnostic methods in the evaluation of thyroid nodules. However, a relevant number of patients with the final diagnosis of benign thyroid nodules receive thyroid surgery more for diagnostic than for therapeutic purposes. A classical criterion of malignancy is a hard or firm consistency upon palpation or ultrasound-probe pressure. Previously this attribute was subjective and dependent on the experience of the examiner. With the introduction ultrasound-based elastography a reproducible qualitative assessment of tissue consistency became available. The aim of the present article is to provide an update of the literature on different available techniques and the results reported both for thyroid nodules differentiation and for diffuse thyroid disease evaluation. Advantages and limitations of elastography are also discussed.