What are the ATA diagnostic guidelines for medullary thyroid carcinoma?

Updated: May 14, 2020
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Patients with medullary thyroid carcinoma can be identified by pathologic diagnosis or by prospective genetic screening. According to the revised ATA guidelines, an FNAB result suspicious for medullary thyroid carcinoma should prompt the following [31] :

  • Ultrasonography of the neck
  • Serum calcitonin assay
  • Serum carcinoembryonic antigen (CEA) measurement
  • DNA analysis for  RET germline mutation

According to 2009 ATA guidelines, a calcitonin level >100 pg/mL should be considered suspicious of medullary thyroid carcinoma. [39] Although calcitonin is a valuable tumor marker in patients with medullary thyroid carcinoma, the 2015 revised ATA guidelines note that clinical judgment should be exercised in the interpretation of calcitonin test results. Serum levels can be falsely high or low in a variety of clinical diseases, can be elevated in children under 3 years of age, and can be higher in males than females. [31]

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