Combination of Ultrasound-Guided Percutaneous Microwave Ablation and Radioiodine Therapy in Benign Thyroid Disease: A 3-Month Follow-Up Study

Abstract

Purpose: Pilot studies of combined therapies treating benign nodular goiters reported promising results. The aim of this study was to investigate the effectiveness of combined microwave ablation (MWA) and radioiodine therapy (RIT) with a special focus on thyroid function at the 3-month follow-up. Materials and Methods: 15 patients (median age: 55 years) with a large goiter and benign thyroid nodules or Graves? disease were treated with the combined therapy. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobuline (Tg) and, additionally, antibody levels against thyroglobulin (TgAb), thyrotropin receptors (TRAb) and thyroid peroxidase (TPOAb) were measured at enrollment, post MWA and at the 3-month follow-up (3MFU). Furthermore, the goiter volume, I-131 dose and hospitalization time were analyzed to evaluate effectiveness. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928?MHz. Results: TSH, T4, T3 and Tg did not change at 3MFU, except for in two patients in whom the initial TSH levels improved to normal thyroid functioning levels at follow-up.?One of the patients developed a high TRAb-level that receded back into the normal range. At 3MFU, the combined therapy showed a mean thyroid volume reduction of?26.4?ml ??7.9?ml (30.5?% ??4.6?% (p?<?0.05)). By?utilizing the combined therapy, administered activity could be reduced by 26.6?% ??4.8?% (p?<?0.05) and hospitalization time by 30.9?%???19.9?% (p?<?0.05). Conclusion: The data confirmed the effectiveness of the combination of MWA with RIT. The combined therapy is an innovative and conservative approach and could become a safe alternative to surgery for the treatment of very large benign nodular goiters. Due to the short follow-up and the limited number of patients, further studies will be necessary. Key Points: ??The combined therapy shows a significant volume reduction in benign nodular goiters ??Initial MWA improves the RIT results by reducing the required therapy activity ??Thyroid function is preserved after combined therapy Citation Format: ??Korkusuz H, Happel C, Koch DA. et?al. Combination of Ultrasound-Guided Percutaneous Microwave Ablation and Radioiodine Therapy in Benign Thyroid Disease: A 3-Month Follow-Up Study. Fortschr R?ntgenstr 2016; 188: 60???68

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Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation, feasibility and efficiency – preliminary results

“…Two patients showed TSH levels below the normal range, but all patients were clinically euthyroid. No serious complications occurred, and the authors concluded the combination of MWA and RIT was "an effective approach for the treatment of large benign nodular goitres" [36].…”

“…The combination of a local ablative procedure with RIT could help make this treatment safer and available to a higher number of patients. The first approaches of combined therapy showed promising results [9,10,17,36]. An early prospective randomised study by Zingrillo et al from 2003 [10] described the combined therapy of PEIT and RIT in comparison to RIT single therapy in large (>4 cm) toxic thyroid nodules (TTNs).…”

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Ultrasound‐Guided Percutaneous Microwave Ablation for Substernal Goiter: Initial Experience

“…As a relatively new technique for thyroid disease, US-guided MWA has been difficult for many patients with SSG to accept. In terms of the follow-up period, based on previous studies of thermal ablation for thyroid nodules, [28][29][30] although the reduction rate continuously increases over a few months, the greatest reduction of volume is achieved within the first few months. In addition, as the results show, at the 3-month follow-up, the major volume reduction and symptom relief had already occurred without complications or unexpected side effects.…”