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

• DOI: 10.1089/thy.2006.0204
• Publication Date: 2007-03-26T11:29:43Z
• Authors: Enrico Papini; Rinaldo Guglielmi; Giancarlo Bizzarri; Filomena Graziano; Antonio Bianchini; Claudia Brufani; Sara Pacella; Dario Valle; Claudio M. Pacella
• Keywords: Adult; Male; Receptors, Thyroid Hormone; Lasers; Thyroid Gland; Thyrotropin; Middle Aged; Administration, Cutaneous; 3. Good health; Thyroxine; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Odds Ratio; Humans; Female; Prospective Studies; Thyroid Nodule

To compare clinical and ultrasound (US) changes induced in cold thyroid nodules by US-guided percutaneous laser ablation (PLA) versus follow-up or levothyroxine (LT4) suppressive therapy.62 patients randomly assigned to a single PLA (Group 1), LT4 (Group 2), or follow-up (Group 3). Entry criteria: euthyroid patients with a solid thyroid nodule >5 mL and benign cytological findings.Group 1: PLA was performed with a 1.064 mum neodymium yttrium-aluminum-garnet laser with output power of 3 W for 10 minutes; Group 2: the LT4 dose was adjusted to induce thyrotropin suppression; Group 3: no treatment.In Group 1 a significant nodule reduction was found 6 and 12 months after PLA (delta volume: -42.7 +/- 13.6%; p = 0.001). A reduction >50% was found in 33.3% of cases. In Group 2 a nonsignificant nodule shrinkage was observed. A nonsignificant volume increase was observed in Group 3. Improvement of local symptoms was registered in 81.2% of patients in Group 1 vs. 13.3% in Group 2 and 0.0% in Group 3 ( p = 0.001). No complications were noted.A single PLA induced significant volume reduction and improvement of local symptoms. PLA was more effective than LT4. Follow-up was associated with nodule growth and progression of local symptoms. PLA should be considered a potential mini-invasive alternative to surgery in symptomatic patients with benign cold thyroid nodules.