Laser-induced thermal ablation was a safe and effective ablative treatment for a patient with PTMC confined to the thyroid gland who was at high surgical risk. This approach should be considered only in elderly patients and/or in those with comorbidities that might expose the patients to an undue high surgical risk and only after the evaluation by neck US, computed tomography, magnetic resonance imaging, or positron emission tomography/computed tomography rules out lymph-node involvement or metastatic disease.
Objective: (a) To compare the efficacy of low-activity (2 GBq; 54 mCi) 131 I ablation using L-thyroxine withdrawal or rhTSH stimulation, and (b) to assess the influence of thyroid remnants volume on the ablation rate. Design: Patients underwent neck ultrasound, 131 I neck scintigraphy and radioiodine uptake. Posttherapy whole body scan (WBS) was acquired after 4-6 days. Ablation was assessed after 6-12 months by WBS, Tg and TgAb following L-thyroxine withdrawal. Methods: Group A: preparation by L-T 4 withdrawal (37 days); 21 patients received 131 I (2.02G 0.22 GBq; 54.6G5.9 mCi) and on the day of treatment, TSH, Tg, TgAb were measured; Group B: stimulation by rhTSH; 21 patients received 131 I (1.97G0.18 GBq; 53.2G4.9 mCi) 24 h after the second injection of rhTSH (0.9 mg) and TSH, Tg and TgAb were measured after 2 days. Results: At follow-up, 90.0% of patients from group A and 85.0% of patients from group B had Tg levels !1 ng/ml; no uptake was observed in 95.2% and in 90.5% of patients from group A or B respectively, with no statistical differences for both ablation criteria. Before 131 I treatment, small thyroid remnants (!1 ml) were detected by US in !25% of all patients. Conclusions: The use of rhTSH for the preparation of low-risk patients to ablation therapy with low activities of 131 I (2 GBq; 54 mCi) is safe and effective and avoids hypothyroidism. The presence of thyroid remnants smaller than 1 ml at US evaluation had no effect on the ablation rate.
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