Single-Session High-Intensity Focused Ultrasound Treatment for Persistent or Relapsed Graves Disease: Preliminary Experience in a Prospective Study

Abstract

Purpose To evaluate the safety and efficacy of ultrasonography (US)-guided high-intensity focused ultrasound (HIFU) ablation as a treatment for medically refractory Graves disease (GD). Materials and Methods After ethics approval, a prospective trial (NCT02685514) was performed from November 2015 to February 2016. Thirty patients underwent ablation of the entire right and left thyroid lobes, with areas near the tracheal-esophageal groove and common carotid artery left unablated. Serum thyroid-stimulating hormone (TSH), free T4 (FT4), antithyroid autoantibodies, and TSH receptor (TSHR) antibody levels were evaluated afterward, and US color Doppler, US volumetry, and eye assessment were performed. The primary outcome was the 12-month relapse rate. Relapse referred to hyperthyroidism (FT4 > 23 pmol/L) afterward. Variables associated with relapse were analyzed by using binary logistic regression. Results The technical success rate was 96.7%. The cohort comprised entirely women, with a median age of 38.2 years (interquartile range, 29.5-49.0 years). After 12 months, eight patients (26.7%; 95% confidence interval [CI]: 14.19%, 44.95%) experienced relapse. One patient (3.3%; 95% CI: 0.59%, 16.67%) experienced vocal cord palsy, while two patients (6.7%; 95% CI: 1.85%, 21.33%) experienced Horner syndrome, but none of these conditions were permanent. No changes in gland volume, antithyroid autoantibody levels, and ophthalmic parameters were found at 12-month follow-up. Baseline TSHR was found to have decreased significantly at 6- and 12-month follow-up (P < .001 for both). TSHR antibody (odds ratio [OR] = 1.414; 95% CI: 1.018, 1.965; P = .039) and gland volume (OR = 0.557; 95% CI: 0.353, 0.880; P = .012) were associated with 12-month relapse, with higher antibody levels conferring a higher likelihood and smaller gland volumes conferring a lower likelihood. Conclusion US-guided HIFU of the thyroid may be a safe and efficacious treatment in patients with persistent or relapsed GD. However, further study is warranted before it can become mainstream for this indication. RSNA, 2017 Online supplemental material is available for this article.

Ultrasound-Guided Percutaneous Microwave Ablation for Solid Benign Thyroid Nodules: Comparison of MWA versus Control Group

“…Procedure-related major complications including recurrent laryngeal nerve paralysis and Horner syndrome occurred in two and one cases, respectively. Since the recurrent laryngeal nerve was close to the treated nodule when it was located in the danger triangle, we believe it was a technical error caused by directing the thermal energy too close to this region [ 23 ]. Horner syndrome, presenting as a combination of ptosis, miosis, and anhidrosis of the face, could be caused by thermal injury to the middle cervical sympathetic ganglion (mCSG) [ 24 ].…”

Long-Term Outcomes Following Thermal Ablation of Benign Thyroid Nodules as an Alternative to Surgery: The Importance of Controlling Regrowth

“…Gambelunghe et al [19] suggested that complete ablation (or a very high percentage of ablation) is essential to achieve a marked reduction in the thyroid nodule. In a high intensity focused ultrasound study of mild Graves' disease, Lang et al [36] hypothesized that the ablation volume ratio may be a factor in disease relapse.…”

The Efficacy and The Safety of Ultrasound-guided Ablation Therapy for Treating Papillary Thyroid Microcarcinoma

“…Lang B.H. et al applied HIFU into benign thyroid diseases such as Gravels Disease 55 and large-size benign thyroid nodules 56, HIFU had excellent safety and efficacy in treating thyroid disorders above. However, in PTMC field, the HIFU research was not published yet and needed researcher to investigate step by step.…”