Localization of Metastatic Medullary Thyroid Carcinoma by Immunoreactive Calcitonin Assay

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Abstract
Using a specific radioimmunoassay for human calcitonin (Argemi, 1973) the same study was done in 3 patients operated on for medullary carcinoma, to localize the secreting tissue and determine whether this method of diagnosis is successful. In the 1st case only 3 venous samples were collected during surgery, after a previous operation which removed only the right thyroid lobe (in which the tumor was located). The highest IRCT [immunoreactive calcitonin] level was found in the right thyroid vein, and on this side, a metastatic lymph node was discovered. In the 2 other patients, IRCT levels remained high after surgery. Multiple venous samples were collected for IRCT assay during retrograde venous catheterization. In case 2, lymphography revealed large metastatic lateroaortic lymph nodes in the pelvis, which is an unusual localization of metastatic medullary carcinoma. The high IRCT level in the right hepatic vein and left innominate vein also suggested the presence of diffuse metastases. In case 3, the removal of an adherent tumor with bilateral lymphatic metastases was incomplete, and plasma IRCT remained high in the internal jugular veins, but the high level in the left innominate vein, and a slight enlargement of the upper mediastinum on X-ray examination, also suggested the presence of mediastinal lymphatic metastases. The IRCT assay in multiple venous samples collected by catheterization appears to be a useful method to localize secreting tissue after surgery for medullary carcinoma, but the gradient of IRCT in the various venous samples is not necessarily very high, and this implies that multiple samples must be collected from the same vein to obtain a precise localization of secreting tissue.

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