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RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous Lobectomy. Eun Ju Ha 1 , Jung Hwan Baek 1 , Jeong Hyun Lee 1 , Jin Young Sung 2 , Jae Kyun Kim 3 , Young Kee Shong 4 - PowerPoint PPT Presentation
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Eun Ju Ha1, Jung Hwan Baek1, Jeong Hyun Lee1, Jin Young Sung2,
Jae Kyun Kim3 , Young Kee Shong4
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center
2Department of Radiology, Thyroid Center, Daerim St. Mary’s Hospital
3Department of Radiology, Chung-Ang University College of Medic ine
4Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center
RF Ablation of Benign Thyroid Nod-
ules Does Not Affect Thyroid Function
in Patients with Previous Lobectomy
Previous lobectomy patientsSymptomatic benign thyroid nodule in the remaining thyroid gland
What would be the best treatment option for this patient?
For patients with previous lobectomy
Surgical treatment
① Risks of recurrent laryngeal nerve injury and hypoparathyroidism
② Permanent hypothyroidism
Introduction
Monzani et al. 1997. Clin Endocrinol (Oxf) 46:9-15
Baek et al. AJR Am J Roentgenol 194:1137-1142
Papini et al. 2008. Curr Opin Endocrinol Diabetes Obes 15:434-439
Valcavi et al.2010.Thyroid 20:1253-1261
Lefevre et al. 2007. Langenbecks Arch Surg 392:685-691
Rafferty et al. 2007. J Am Coll Surg 205:602-607
Non-surgical treatments (RF-, laser- and ethanol ablation)
attractive treatment options that may preserve thyroid function
Regarding thyroid function,
Transient hyperthyroidism in a few patients
Permanent hypothyroidism in two patients: the reason was unclear
Thyroid function seems to be rarely influenced by RF ablation
but no studies in patients with previous lobectomy
RF ablation
Kim et al.2006.Thyroid 16:361-367
Jeong et al. 2008. Eur Radiol 18:1244-1250
Baek et al. 2012. Radiology 262:335-342
To evaluate whether RF ablation for the treatment of benign
thyroid nodules affects thyroid function in patients with
previous lobectomy
Purpose
Inclusion criteria
2002.6-2009.1222 patients of previous lobectomy due to benign thyroid nodules
Inclusion criteria
11 patients with 14 thyroid nodules
7 patientsHypothyroidism before RFA
4 patientsFU for less than 6-month
Exclusion
Materials & Methods(1) predominantly solid nodule (2) pressure symptoms or
cosmetic problems(3) cytologic confirmation of
benignancy at least twice (4) no malignant features de-
tected using US (5) refusal of surgery
The Procedure of RF ablation
By an experienced radiologist
Using the Cool-Tip RF system, Internally cooled electrode
Using the Moving shot technique
Materials & Methods
< Illustration for Moving Shot Technique>
Baek et al. 2011 Korean J Radiol. 12:525-540
Pre-procedural evaluation
Clinical concern: symptomatic (0-10) / cosmetic (1-4) scores
US examination: the largest diameter, volume
Laboratory test: TSH, fT4, T3, anti-TPO/Tg/TSHRc Ab
Follow-up periods
Clinical concerns, US examination: 1-, 6-month, and last F/U
Laboratory test: 6-month, and last F/U
Complications
Materials & Methods
Statistical analysis
SPSS for Windows (version14.0; SPSS, Chicago, IL)
Compare the variables at the time of enrollment and the last F/U
: Wilcoxon’s signed rank test
Materials & Methods
Follow-up duration : 43.7 ± 30.7 months
Interval (surgery- RF ablation): 122.9 ± 151.3 months
Efficacy
Characteristic Enrollment Last follow-up P value
Volume (mL) 9.7±36.3 (0.9-57.6) 2.8±12.4 (0.0-17.9) 0.001
Symptom score 4.6 ± 2.1 (2-9) 1.4 ±0.7 (0-5) 0.003
Cosmetic score 3.5 ±0.0 (3-4) 1.5±0.7 (1-3) 0.003
VRR at last follow-up : 87.2%
Results
Thyroid Function
Thyroid Antibodies
None of the patients showed newly developed thyroid antibodies during the F/U
Characteristic Enrollment Last follow-up P value
Thyrotropin (mU/mL) 1.7±1.1 (0.4-3.8) 2.0 ± 1.2 (0.8-4.0) 0.306
Free thyroxine (ng/dL) 1.4± 0.1(1.0-1.9) 1.4±0.2 (0.9-2.4) 0.789
Triiodothyronine (ng/dL) 113.3±6.4 (80.2-133.0) 113.3±21.2 (82.4-151.0) 0.878
Results
Each value is the mean ± SD, with the range in parenthesis
Results
1.77 1.09 114 (-/-/-)
92-month F/U
Complications : no major complications including voice change
None of the patients required additional surgery
Results
Case
2 RF ablations Improvement of symptomatic andcosmetic problems
Thyroid function was well preserved in all patients The efficacy is usually confined to targeted nodules
=> damage to surrounding normal thyroid gland can be minimized
Discussion ①
Comparison with LA and EA
Baek et al. Baek et al. Valcavi et al. Monzani et al. Livraghi et al.
Published journal Radiology WJS Thyroid Clin Endocrinol Radiology
Published year 2012 2009 2010 1997 1994
Ablation methods RF RF Laser EA EA
N. of patients 1459 9 122 117 101
Mean diameter 3.8 ± 1.4 cm 3.2 ± 1.4cm 1.5 - 7.0 cm
(range)
> 3cm
Hypothyroidism 1 1 2 1 1
Thyroid Abs TPO Ab Tg Ab TPO Ab/Tg Ab TPO Ab/Tg Ab TPO Ab
Note. NFTN AFTN NFTN AFTN AFTN
Discussion ②
Abbreviations: Tg: Thyroglobulin, TPO: Thyroid peroxidase, Ab: antibodyNFTN: nonfunctioning thyroid nodule, AFTN: autonomously functioning thyroid nodule
The cause of hypothyroidism…
Discussion ②
Progression of autoimmune thyroiditis
Treatment of autonomously functioning thyroid nodule (AFTN)
It may be necessary to warn the patients with thyroid antibodies
and the patients with AFTNs about the possibility of
hypothyroidism prior to the treatment
In patients with previous lobectomy,
RF ablation
has advantages in terms of maintaining thyroid function
should be considered as a first-line treatment
Conclusion
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