Percutaneous laser ablation of benign thyroid nodules: a one year follow-up study

Antonio Rahal Junior, Priscila Mina Falsarella, Guilherme Falleiros Mendes, Jairo Tabacow Hidal, Danielle Macellaro Andreoni, José Flávio Ferreira Lúcio, Marcos Roberto Gomes de Queiroz, Rodrigo Gobbo Garcia, Antonio Rahal Junior, Priscila Mina Falsarella, Guilherme Falleiros Mendes, Jairo Tabacow Hidal, Danielle Macellaro Andreoni, José Flávio Ferreira Lúcio, Marcos Roberto Gomes de Queiroz, Rodrigo Gobbo Garcia

Abstract

Objective: To evaluate safety and effectiveness of nodule volume reduction and thyroid function after percutaneous laser ablation treatment in patients with benign nonfunctioning thyroid nodules.

Methods: Prospective single-center study, from January 2011 to October 2012, which evaluated 30 euthyroid and thyroid antibodies negative patients with benign solitary or dominant nodule with indication of treatment due to compressive symptoms and aesthetic disturbances. The clinical and laboratory (thyroid ultrasound, TSH, FT4, TG, TG-Ab, TPO-Ab and TRAb levels) evaluations were performed before the procedure, and periodically 1 week, 3 months and 6 months after. The ablation technique was performed under local anesthesia and sedation. In each treatment, one to three 21G spinal needle were inserted into the thyroid nodule. The laser fiber was positioned through the needle, which was then withdrawn 10mm to leave the tip in direct contact with the nodule tissue. Patients were treated with a ND: Yag-laser output power of 4W and 1,500 to 2,000J per fiber per treatment. The entire procedure was performed under US guidance.

Results: Thirty patients, with a total of 31 nodules submitted to laser ablation were evaluated. The median volumetric reduction of the nodule was approximately 60% after 12 months. No statistical significance was observed on thyroid function and antibodies levels. There was a peak on the level of thyroglobulin after the procedure due to tissue destruction (p<0.0001). No adverse effects were observed.

Conclusion: Percutaneous laser ablation is a promising outpatient minimally invasive treatment of benign thyroid nodule.

Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1. Ultrasonography of thyroid after procedure…
Figure 1. Ultrasonography of thyroid after procedure showing absence of central vascularization. (A) Pre-ablation ultrasonography with a 3cm on the largest axis predominantly solid thyroid nodule in the right lobe. (B) Insertion of the optic fiber (arrows) into the thyroid nodule. (C) Gas formation (arrow) during the procedure. (D) Ultrasonography of thyroid after procedure showing increased hypoechogenicity and absence of central vascularization. (E) Ultrasonography of thyroid after procedure showing absence of central vascularization
Figure 2. Percentage reduction of nodules
Figure 2. Percentage reduction of nodules
Figure 3. Thyroid-stimulating hormone and serum-free thyroxine…
Figure 3. Thyroid-stimulating hormone and serum-free thyroxine mean levels
Figure 4. Anti-thyroid-stimulating hormone-receptor antibodies, antithyroglobulin, antithyroid…
Figure 4. Anti-thyroid-stimulating hormone-receptor antibodies, antithyroglobulin, antithyroid peroxidase mean levels
Figure 5. Evolution of thyroglobulin
Figure 5. Evolution of thyroglobulin

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