The calcitonin stimulation test with calcium, used for diagnosing medullary thyroid carcinoma (MTC), is well tolerated by patients with MTC, researchers from the National Institute of Endocrinology and the University of Medicine and Pharmacy in Bucharest, Romania concluded.
Nonetheless, they advise that “continuous cardiac monitoring during the test should be performed to guarantee rapid intervention should an adverse cardiovascular event occur, although this is very rare.”
The most frequently observed adverse reactions were hot flashes (159/176), dysgeusia (32/176), and bradycardia (10/176). One patient developed severe bradycardia, which was quickly managed and reversible. Nine patients did not experience any adverse reactions.
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The study authors did not find any correlations between disease severity and patient age, weight, height, body mass index, basal calcitonin, or peak stimulated calcitonin. However, they did find that men were more likely to develop cardiovascular side effects than women. These included bradycardia, tachycardia, ventricular or atrial extrasystoles, hypertension, hypotension, and angina.
Băetu et al recommended thyroid surgery in all Romanian women with stimulated calcitonin levels above 285 pg/mL. They also recommended measuring calcitonin in thyroid nodule screening and performing the calcium stimulation test when calcitonin levels are elevated, to allow for an early diagnosis of thyroid malignancy.
They stated, “The potency of the [calcitonin] stimulation test with [calcium], the low cost, and the availability of [calcium] along with minimum side effects strongly support the necessity for the test to be standardized with a precise protocol.”
This study included 176 patients, of which 115 were women (median age, 46 years; range, 21–79 years) and 61 were men (median age, 54 years; range, 22–78 years). The levels of calcitonin were registered 2, 5, and 10 minutes before and after calcium administration.
Băetu M, Olariu CA, Nițu I, Moldoveanu G, Corneci C, Badiu C. Safety of calcitonin stimulation tests with calcium. Hormones (Athens). Published online September 1, 2021. doi:10.1007/s42000-021-00315-0