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Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and
Stefano Spiezia1, Giovanni Vitale, Carolina Di Somma
1Department of Surgery, Ultrasound Guided & Neck Pathologies Surgery Unit, S. Maria del Popolo degli Incurabili Hospital ASL NA1, Naples, Italy. stefanospiezia@tiscali.it
Objective:
Percutaneous laser thermal ablation (LTA) has been applied in several tumors. In this study we evaluated the safety and long-term efficacy of LTA in the treatment of benign thyroid nodules.
Design And Patients:
Seven patients with autonomous hyperfunctioning thyroid nodule (group A) and five patients with compressive nodular goiter (group B) were treated with LTA. Up to three needles were positioned centrally in the thyroid nodule and laser fiber was placed in the lumen of the needle. Laser illumination was performed reaching a maximal energy deposition of 1800 J per fiber.
Measurements:
Thyroid nodule volume, endocrinologic, and clinical evaluation were performed at baseline, 3, and 12 months after the treatment. Scintigraphy was performed at diagnosis and 12 months after the first session in group A.
Results:
In group A, mean thyroid volume decreased from 3.15 +/- 1.26 mL to 0.83 +/- 0.49 mL (p < 0.001) after 12 months. The treatment induced disappearance of clinical signs and symptoms related to hyperthyroidism; normalization of free triiodothyronine (FT(3)), free thyroxine (FT(4)), and thyrotropin (TSH) serum levels and recovery of extranodular uptake at scintiscan. In group B, mean thyroid volume decreased from 11.14 +/- 4.99 mL to 3.73 +/- 1.47 mL (p < 0.01) after 12 months. Pressure symptoms in the neck, difficulty in swallowing and tracheal displacement improved in all patients. The treatment was well tolerated in both groups of patients.
Conclusions:
LTA appears to be a valid and safe alternative approach in the treatment of benign thyroid nodules.