Treatment of Benign Cold Thyroid Nodules: A Randomized Clinical Trial of Percutaneous Laser Ablation Versus Levothyroxine Therapy or Follow-up

Papini, Enrico; Guglielmi, Rinaldo; Bizzarri, Giancarlo; Graziano, Filomena; Bianchini, A.; Baratto, Claudia; Pacella, Sara; Valle, D.; Pacella, Claudio M.

doi:10.1089/thy.2006.0204

Cited by 149 publications

(113 citation statements)

References 31 publications

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“…25,26 By using laser ablation and microwave ablation, the mean VRR of laser ablation and microwave ablation was 44-62% and 46-65% at the 6-month follow-up. 5,20,27,28 In another study, Jeong et al 9 reported the clinical practice of MRFA for benign thyroid nodules in 236 patients and the mean VRR was 84.79% at the 6-month follow-up. Our result was at least equivalent to that of Jeong's with a MRFA system and seemed to be better than that achieved by laser ablation and microwave ablation.…”

Section: Discussionmentioning

confidence: 98%

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Treatment efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation for benign thyroid nodules

et al. 2016

BJR

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Section: Discussionmentioning

confidence: 98%

“…Similarly, in laser ablation and microwave ablation, the incidence of nerve injury was 0-8% and 0-4.3%. [20][21][22]27,31 This difference suggests that more security might be expected if BRFA is used in thyroid nodules. Thyroid function tests of BRFA group were normal after treatment in this study.…”

Section: Discussionmentioning

confidence: 99%

Treatment efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation for benign thyroid nodules

et al. 2016

BJR

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“…The patient is placed in a supine position with neck hyperextended. The procedure is performed under ultrasound system guidance [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. In most studies, a 21-G needle is inserted into the lesion along its longest axis.…”

Section: La Devices and Proceduresmentioning

confidence: 99%

“…A laser source, a continuous-wave Nd-YAG laser operating at 1.064 lm, is used with an optical beam-splitting device with as many as four separate fibers that can be illuminated separately or concurrently [12]. The total energy applied is usually between 1.200 and 1.800 Joules [57,59,63,67,73], with a continuous output power of 1.5 and 3.5 W [57, 59-61, 64-72, 74].…”

Section: La Devices and Proceduresmentioning

confidence: 99%

Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.Keywords Laser Á Radiofrequency Á Microwave Á Highintensity focused ultrasound Á Thyroid nodule SOMMARIO I noduli benigni della tiroide sono una evenienza comune nella popolazione generale. Più spesso vengono scoperti occasionalmente durante un esame ecografico fatto per altri motivi, sono asintomatici e non richiedono alcun trattamento. Qualora i noduli diventino sintomatici, l'escissione chirurgica è ancora considerato il trattamento standard. Tuttavia, negli ultimi anni, è cresciuta l'esperienza circa il trattamento di tali noduli tramite ablazione percutanea sotto guida ecografica tanto che, attualmente, questo viene spesso proposto come trattamento di scelta. Lo scopo del nostro lavoro è fare una revisione della letteratura riguardante l'argomento, con un particolare focus sulle differenti tecniche attualmente a disposizione, in particolare radiofrequenza (RFA), laser (LA), microonde (MWA) e high-intensity-focus ultrasound (HIFU). Al momento ci sono ancora poche evidenze sull'efficacia di MWA e HIFU. Secondo quanto riportato in letteratura, buoni risultati sono stati ottenuti con RFA e LA. Riguardo la radiofrequenza, la riduzione volumetrica dopo la procedura ablativa va da 47 a 84 % a 3-6 mesi e da 62 a 93 % a 1 anno; anche il laser sembra essere efficace nel causare la riduzione del nodulo, con percentuali che vanno da 37 a 81 % a 3-6-mesi a da 13 a 82 % a 1 anno di follow-up Abbiamo poi discusso brevemente le

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“…Of these eight, we sent a request for data to the authors of three studies [17][18][19] as the data in the papers were insufficient to decide how many people failed in either one or both treatment groups. As of the time of The thyroid measurement is reduced but to < 50% palpation based Thyroxine suppression therapy for benign thyroid nodules submission of this paper, the authors had not responded to our requests for the missing data.…”

Section: Quantitative Synthesismentioning

confidence: 99%

Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis

Yousef

Clark

Doi

2010

Clinical Medicine & Research

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Levothyroxine (LT4) suppressive therapy for solitary thyroid nodules is not popularly advocated presently because its clinical efficacy and safety are currently considered controversial. This metaanalysis aims to address efficacy issues by using rigorous methods to arrive at a pooled estimate. On the basis of the analysis, it is estimated that LT4 therapy is clearly associated with up to a two-fold increase in the chance of nodule reduction. This translates to a number needed to treat (NNT) of 6 or a 50% decrease in the risk of cancer given nodule reduction. Keeping this definition of efficacy in mind and a low incidence of adverse events with low level LT4 suppression, such an intervention might be appropriate in patients selected on the basis of a low risk for adverse effects. The natural history of thyroid nodules suggests that a third of benign nodules will spontaneously grow to more than 15% of its initial size within one year and this increases to almost all (89%) at five years if these nodules are not treated somehow. 1 The majority of growth has been found in those nodules that have a more solid component. Although the pathogenesis of such growth is poorly understood, thyroid-stimulating hormone (TSH) is presumed to be necessary if not sufficient, and therefore suppression of TSH secretion might be expected to result in a decrease in nodule size or at least prevent any further enlargement.Benign solitary nodules detected by physical examination represent two different pathological processes. In many of these patients, the palpated nodule could simply be the dominant nodule of a multinodular goiter while other solitary nodules are probably true solitary adenomas. The latter can be distinguished by ultrasound and nonrandomized, uncontrolled trials have found that patients with solitary nodules had lesser decreases in nodule size in response to thyroxine therapy than patients with nontoxic diffuse or multinodular goiters.2 Of the randomized trials that have been published, the majority demonstrated some degree of efficacy of thyroxine therapy for solitary thyroid nodules. Meta-analyses of these trials was first attempted in 1998 and showed a reduction in thyroid solitary nodule volume in 17% of patients treated with levothyroxine and inhibition of nodule growth in another 10%.3 A second meta-analysis found that nodules decreased by more than 50% in more patients who received thyroxine therapy, but the treatment response did not reach statistical significance (relative risk [RR] 1.9; 95% confidence interval [CI] 0.9 to 3.8).4 Also, there have been concerns about subclinical hyperthyroidism in treated patients who may be at increased risk for atrial

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Treatment of Benign Cold Thyroid Nodules: A Randomized Clinical Trial of Percutaneous Laser Ablation Versus Levothyroxine Therapy or Follow-up

Cited by 149 publications

References 31 publications

Treatment efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation for benign thyroid nodules

Treatment efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation for benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis

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