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072 - Follow up of thyroid carcinoma: the questions of clinicians, the answers of laboratorians

Autor(s): R.M. Dorizzi, R. Castello, L. Giovanella, F. Zambotti

Issue: RIMeL - IJLaM, Vol. 4, N. 3-S1, 2008 (MAF Servizi srl ed.)

Page(s): 72-81

Thyroid cancer is 2-4 folds more frequent in females that in males even if malignancy is more frequent in males. Thyroid carcinoma management must take account of its low rate (0.7% of all cancers, 2.5% in women, with 0.2% deaths in men and 0.5% in women). The prognosis of differentiated thyroid carcinoma is good in 85% of cases. The management of this disease requires a multidisciplinary approach involving clinical examination, laboratory, ultrasonography and whole body scanning. Many guidelines have been proposed discussing the role of the laboratory and the major outlined points are: a TSH assay with high functional sensitivity must be preferred, thyroglobulin must be used only in follow-up of thyroidectomized patients, calcitonin should be requested only in selected cases. The most relevant analytical issues are: the lack of an international standard; inadequate sensitivity and precision; antithyroglobulin antibodies interference, hook effect. The measurement of calcitonin is being advocated in the management of medullary thyroid carcinoma, once other causes of increased calcitonin, such as kidney failure and endrocrine cancer (i.e. lung or pancreas cancer) have been excluded. The calcitonin levels are influenced by the differences between methods by different physio-pathological conditions; therefore also in this case interaction between clinicians, laboratorians and manufacturers is needed.

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