BackgroundHigh-intensity focused ultrasound (HIFU) is a promising, non-invasive technique in treating benign thyroid nodules (TNs). The aim of this study was to evaluate the efficacy of HIFU to induce clinically meaningful shrinkage in benign predominantly solid TNs and to identify variables that influence or predict the magnitude of TN volume reduction.MethodsFor each of ten subjects, HIFU treatment was conducted on a single nodule. Nodular volume was measured sonographically at baseline and at 3 months post-procedure. Nodular function and early treatment assessment was done scintigraphically.ResultsMedian nodular volume reduction was 0.7 ml absolute and 48.8% relative to pre-interventional size (p < 0.05). Absolute shrinkage was negatively correlated with the average treatment depth (τ = −0.61, p < 0.05). Absolute nodular volume was positively correlated with the scintigraphic nodular uptake reduction (τ = 0.66, p < 0.05).ConclusionsHIFU treatment of benign predominantly solid TNs appears to be safe and effective for inducing nodular shrinkage. Despite potential for improvement, a single treatment session with HIFU is already a viable alternative to more standard methods. The feasibility of multiple HIFU treatments requires further investigation. Due to the small sample size, the findings of this analysis need conformation by larger studies.
• Thermal Ablation can be used to treat benign thyroid nodules • Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy • Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective.
The data suggest MWA as an alternative for the treatment of benign thyroid nodules. While first results for preservation of thyroid function are positive, further measurements of laboratory data and especially antibodies are necessary.
Purpose: The aim of this study was to assess the effectiveness of high intensity focused ultrasound (HIFU) in reducing thyroid nodule volume while preserving thyroid function as measured by immunological response.
Materials and Methods: 12 patients (9 females) whose average age was 56.9 years (37???81) were treated with HIFU in an ambulatory setting. All patients had a single benign thyroid nodule treated in one HIFU session. The median nodular outline volume (NOV) was 3.4?ml (range 0.6???5.0?ml). The therapeutic ultrasound probe (Echopulse? THC900?888-H) used works with a frequency of 3?MHz, reaching temperatures of 80???90? C and a mean output between 87.6 and 192.8?W. To assess possible effects of HIFU on thyroid function, serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobulin (hTg) and antibodies against thyroglobulin (TAbs), thyrotropin receptors (TRAbs) and thyroid peroxidase (TPOAbs) were measured at enrollment, 24-hours post-HIFU treatment and at 3-month follow-up.Pre- post thyroglobulin reduction was measured to evaluate the success of ablation and the nodular outline volume (NOV) was evaluated at baseline and the 3-month follow-up to assess effectiveness.
Results: All measured hormone levels were within normal ranges and remained stable (p?>?0.05). No clinically meaningful immune reaction was induced (p?>?0.05). Thyroglobulin serum levels increased significantly at 24 hours after ablation (p?0.05) and decreased significantly at the 3-month follow-up (p?0.05), returning to pre-ablative levels. The median reduction in nodular outline volume (NOV) was 55?% (p?0.05).
Conclusion: HIFU is a safe and effective alternative for treating benign thyroid nodules, while preserving thyroid function. Further investigations with multiple treatments should be conducted to evaluate whether additional treatments can achieve greater volume reduction.
Key points:
??HIFU is a safe and effective method to treat thyroid nodules.
??HIFU does not interfere with thyroid gland function.
??HIFU does not induce any immune response like Graves? disease.
Citation Format:
??Korkusuz H, Sennert M, Fehre N et?al. Localized Thyroid Tissue Ablation by High Intensity Focused Ultrasound: Volume Reduction, Effects on Thyroid Function and Immune Response. Fortschr R?ntgenstr 2015; 187: 1011???1015
Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique ('MOST'). Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (<20% solid tissue within the volume of interest). Results Bipolar RFA resulted in a highly significant (p < 0.0001) decrease of nodule volume (ΔV), median 5.3 mL (range 0.13-43.1 mL), corresponding to a relative reduction in mean of 56 ± 17.9%. Median initial volume was 8 mL (range 0.48-62 mL); 3 months after ablation a median volume of 2.3 mL (range 0.3-32 mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1). Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.
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