How is MTC dx?

Basal calcitonin 60-100 pg/ml (pathogneumonic), lower concentrations we may think of other causes (PPI, C-cell hyperplasia, smoking). If mildly elevated we may use calcitonin stimulation test w/pentagastrin or calcium Predictive values after stimulation (>250 in women, >500 in men) Additional investigations preop (24h urine catecholamines rule out pheo, serum Ca exclude hyperpara, Neck CT/MRI if sus of locally advanced disease, germline RET analysis see genetic base, in all pt even w/absent family hx.