Comparison of high intensity focused ultrasound and radioiodine for treating toxic thyroid nodules

Giovanella, Luca; Piccardo, Arnoldo; C, Pezzoli; Bini, Fabiano; Ricci, Riccardo; Ruberto, Teresa; Trimboli, Pierpaolo

doi:10.1111/cen.13738

Cited by 25 publications

(19 citation statements)

References 27 publications

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“…Among all thermal ablation options including HIFU, RFA and laser ablation remain to be the most established and used techniques in the treatment of benign thyroid nodules [25]. In comparison, the adoption for HIFU ablation for both toxic and nontoxic thyroid diseases has been relatively slow as the longer-term efficacy remains unclear [26,27].…”

Section: Discussionmentioning

confidence: 99%

Identifying predictive factors for efficacy in high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a retrospective analysis

Lang

Woo

Chiu

2020

International Journal of Hyperthermia

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Objective: Since it is unclear whether clinical parameters can independently predict the subsequent treatment response following high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules, we aimed to examine clinical factors that may independently predict 12-month efficacy after HIFU treatment. Methods: One hundred and forty patients who had single ablation were categorized into two groups, those with 12-month nodule shrinkage above the median (Group I, n ¼ 70) and with shrinkage below or equal to the median (Group II, n ¼ 70). Baseline characteristics, treatment parameters, percentage change in serum TSH, Free thyroxine (FT4) and thyroglobulin (Tg) from baseline to Day 4 and appearance of microbubbles (hyperechoic marks (HEMs)) during treatment were compared between groups. To determine independent factors, a multivariate analysis was done by logistic regression analysis. Results: Baseline characteristics and treatment parameters were comparable between groups. However, on Day-4, group I had significantly lower serum TSH (0.49mIU/L vs. 0.84mIU/L, p ¼ 0.011) and higher FT4 (22.11 pmol/L vs. 18.47 pmol/L, p ¼ 0.008) than group II. The percentage change in TSH, FT4 and Tg were significantly greater in group I (p ¼ 0.002, p ¼ 0.009 and p ¼ 0.001 respectively). The proportion of HEMs observed during treatment was also significantly higher in group I (42.69% vs. 31.72%, p ¼ 0.030). Among the significant factors, the percentage change in FT4 was the only independent factor for 12-month shrinkage (OR ¼ 1.018, 95%CI ¼1.003-1.032, p ¼ 0.017). Conclusions: Percentage change in serum FT4 on post-treatment Day-4 was an independent blood parameter for the subsequent nodule shrinkage at 12 months. This finding could potentially facilitate the decision for earlier retreatment of treated nodules.

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Section: Discussionmentioning

confidence: 99%

Identifying predictive factors for efficacy in high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a retrospective analysis

Lang

Woo

Chiu

2020

International Journal of Hyperthermia

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“…Thus, TA appears appropriate for patients with small AFTN who decline, or are not amenable to RAI therapy or thyroid surgery. HIFU appears as less effective than RAI since thyroid function normalization DOI: 10.1159/000506513 was obtained at 12-months in 94% of the RAI-treated versus 53% of the HIFU-treated subjects [47]. Data concerning the efficacy of MWA is presently considered insufficient.…”

Section: Hyperfunctioning Nodulesmentioning

confidence: 99%

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

Hegedűs¹,

Frasoldati²,

Negro³

et al. 2020

Eur Thyroid J

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Objective: Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre. Methods: ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries. Results: Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients "often" or "always" to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers < 1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities. Conclusions: US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.

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“…High-Intensity Focused Ultrasound HIFU is less effective than RAI for control of hyperfunctioning nodules. A prospective trial in 2 cohorts treated either with HIFU or RAI demonstrated that euthyroidism at 12 months was obtained in 94% of the RAItreated versus 53% of the HIFU-treated patients [100].…”

Section: Benign Autonomously Functioning Thyroid Nodulesmentioning

confidence: 99%

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

et al. 2020

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Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.© 2020 European Thyroid Association Published by S. Karger AG, Basel Recommendation 1. In adult patients with benign thyroid nodules that cause pressure symptoms and/or cosmetic concerns and decline surgery, image-guided TA should be considered as a costand risk-effective alternative option to surgical treatment or observation alone (1, ØØOO).Recommendation 2. We recommend against the use of TA for asymptomatic lesions (1, ØØØO).

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Comparison of high intensity focused ultrasound and radioiodine for treating toxic thyroid nodules

Abstract: In our series, RAI clearly outperforms HIFU in treating patients carrying TTN and remains the first-line noninvasive treatment in such cases.

Cited by 25 publications

References 27 publications

Identifying predictive factors for efficacy in high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a retrospective analysis

Identifying predictive factors for efficacy in high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules – a retrospective analysis

European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules

2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules

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