Interstitial laser photocoagulation for benign thyroid nodules: Time to treat large nodules
✍ Scribed by Gerardo Amabile; Mario Rotondi; Barbara Pirali; Rosa Dionisio; Lucio Agozzino; Michele Lanza; Luciano Buonanno; Bruno Di Filippo; Rodolfo Fonte; Luca Chiovato
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 254 KB
- Volume
- 43
- Category
- Article
- ISSN
- 0196-8092
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✦ Synopsis
Abstract
Background and Objective
Interstitial laser photocoagulation (ILP) is a new therapeutic option for the ablation of non‐functioning and hyper‐functioning benign thyroid nodules. Amelioration of the ablation procedure currently allows treating large nodules. Aim of this study was to evaluate the therapeutic efficacy of ILP, performed according to a modified protocol of ablation, in patients with large functioning and non‐functioning thyroid nodules and to identify the best parameters for predicting successful outcome in hyperthyroid patients.
Materials and Methods
Fifty‐one patients with non‐functioning thyroid nodules (group 1) and 26 patients with hyperfunctioning thyroid nodules (group 2) were enrolled. All patients had a nodular volume ≥40 ml. Patients were addressed to 1–3 cycles of ILP. A cycle consisted of three ILP sessions, each lasting 5–10 minutes repeated at an interval of 1 month. After each cycle of ILP patients underwent thyroid evaluation.
Results
A nodule volume reduction, expressed as percentage of the basal volume, significantly occurred in both groups (F = 190.4; P < 0.0001 for group 1 and F = 100.2; P < 0.0001 for group 2). Receiver‐operator‐characteristic (ROC) curves were constructed for: (i) percentage of volume reduction; (ii) difference in nodule volume; (iii) total amount of energy delivered expressed in Joule. ROC curves identified the percentage of volume reduction as the best parameter predicting a normalized serum TSH (area under the curve 0.962; P < 0.0001). Intraoperative complications consisted in: (i) mild pain occurring in five (6.5%) patients, (ii) vasovagal reaction in two (2.6%) patients, (iii) fever within 24 hours from ILP in five (6.5%) patients. No major complications including persistent pain, laringeal nerve dysfunction, hypoparathyroidism, pseudocystic transformation, and/or neck fascitis were observed.
Conclusions
ILP represents a valid alternative to surgery also for large benign thyroid nodules, both in terms of nodule size reduction and cure of hyperthyroidism (87% of cured patients after the last ILP cycle). ILP should not be limited to patients refusing or being ineligible for surgery and/or radioiodine. Lasers Surg. Med. © 2011 Wiley‐Liss, Inc.