Giovanni Gambelunghe1, Elisa Stefanetti2, Renato Colella3, Massimo Monacelli4, Nicola Avenia5, Pierpaolo De Feo2. 1. a Department of Internal Medicine , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy. 2. b Studio Tiroide Prof. De Feo , Perugia , Italy. 3. c Institute of Pathological Anatomy , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy. 4. d Department of Endocrine Surgery , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy. 5. e Department of Endocrine Surgery , Azienda Ospedaliero-Universitaria di Terni , Perugia , Italy.
Abstract
PURPOSE: To confirm the effectiveness of laser ablation on toxic nodules in a large population with three years of follow-up. MATERIAL AND METHODS: Between 2009 and 2014, we treated 82 patients with hyperthyroidism related to the presence of a toxic nodular goitre. Patients were pre-treated pharmacologically with methimazole prior to single session of laser ablation (LA) and then followed up every 3 months with FT4 and TSH blood tests as well as ultrasound examination of the nodules treated. RESULTS: All patients responded to the treatment. The median nodule volume decreased from 12 ml (range 5-118 ml) to 5 ml (range 1.2-40 ml) after three years (p < 0.001). The percentage of patients who discontinued methimazole therapy was reduced by increasing the initial volume of the toxic nodule. In nodules with a volume less than 5 ml, all patients were able to suspend methimazole; this percentage was reduced to 90.2% in nodules with a volume between 5 and 15 ml, 61.1% in those with volume 15-25 ml and only 28.5% in nodules larger than 25 ml. We had no major complications but only moderate pain and fever in the evening, a few hours after ablation therapy in 10% of treated patients. CONCLUSIONS: Single session of LA of toxic thyroid nodules is effective and safe, especially in nodules with a volume under 15 ml.
PURPOSE: To confirm the effectiveness of laser ablation on toxic nodules in a large population with three years of follow-up. MATERIAL AND METHODS: Between 2009 and 2014, we treated 82 patients with hyperthyroidism related to the presence of a toxic nodular goitre. Patients were pre-treated pharmacologically with methimazole prior to single session of laser ablation (LA) and then followed up every 3 months with FT4 and TSH blood tests as well as ultrasound examination of the nodules treated. RESULTS: All patients responded to the treatment. The median nodule volume decreased from 12 ml (range 5-118 ml) to 5 ml (range 1.2-40 ml) after three years (p < 0.001). The percentage of patients who discontinued methimazole therapy was reduced by increasing the initial volume of the toxic nodule. In nodules with a volume less than 5 ml, all patients were able to suspend methimazole; this percentage was reduced to 90.2% in nodules with a volume between 5 and 15 ml, 61.1% in those with volume 15-25 ml and only 28.5% in nodules larger than 25 ml. We had no major complications but only moderate pain and fever in the evening, a few hours after ablation therapy in 10% of treated patients. CONCLUSIONS: Single session of LA of toxic thyroid nodules is effective and safe, especially in nodules with a volume under 15 ml.