Giovanni Mauri1,2, Enrico Papini3, Stella Bernardi4,5, Daniele Barbaro6, Roberto Cesareo7, Pierpaolo De Feo8, Maurilio Deandrea9, Laura Fugazzola10,11, Giovanni Gambelunghe8, Gabriele Greco12, Carmelo Messina13, Salvatore Monti14, Alberto Mormile9, Roberto Negro12, Chiara Offi15, Andrea Palermo16, Luca Persani10,17, Federica Presciuttini14, Luigi Alessandro Solbiati18,19, Stefano Spiezia15, Fulvio Stacul20, Marco Viganò21, Luca Maria Sconfienza13,22. 1. Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy. giovanni.mauri@ieo.it. 2. Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), via Ripamonti 435, Milan, Italy. giovanni.mauri@ieo.it. 3. Dipartimento Di Endocrinologia, Ospedale Regina Apostolorum, Albano Laziale, Italy. 4. UCO Medicina Clinica, Ospedale Di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy. 5. Dipartimento Di Scienze Mediche, Università Degli Studi Di Trieste, Trieste, Italy. 6. U.O. Endocrinologia ASL Nordovest Toscana, Toscana, Italy. 7. Unit of metabolic diseases, S. M. Goretti Hospital, Latina, Italy. 8. Interventistica Tiroidea, Casa di Cura Liotti, Perugia, Italy. 9. Endocrinologia, Ospedale Mauriziano Torino, Torino, Italy. 10. Division of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milano, Italy. 11. Department of Patophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy. 12. UO Endocrinologia PO "V. Fazzi", Lecce, Italy. 13. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy. 14. UOC Di Endocrinologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy. 15. Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University, Rome, Italy. 16. Unit of endocrinology and Diabetes, Campus Bio-Medico university, Roma, Italy. 17. Department of Medical Biotechnology and Translational Medicine, Università Degli Studi Di Milano, Milano, Italy. 18. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy. 19. IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy. 20. SC Radiologia, Ospedale Maggiore, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy. 21. Orthopaedic Biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. 22. Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milano, Italy.
Abstract
OBJECTIVES: To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS: Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS: A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS: Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS: • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
OBJECTIVES: To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. METHODS: Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. RESULTS: A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46-70 years) were included. Nodule volume was significantly reduced at all time points (p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. CONCLUSIONS: Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. KEY POINTS: • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
Authors: C M Pacella; G Mauri; G Achille; D Barbaro; G Bizzarri; P De Feo; E Di Stasio; R Esposito; G Gambelunghe; I Misischi; B Raggiunti; T Rago; G L Patelli; S D'Este; P Vitti; E Papini Journal: J Clin Endocrinol Metab Date: 2015-08-14 Impact factor: 5.958
Authors: R Cesareo; A M Naciu; M Iozzino; V Pasqualini; C Simeoni; A Casini; G Campagna; S Manfrini; G Tabacco; A Palermo Journal: Int J Hyperthermia Date: 2018-02-06 Impact factor: 3.914