IL NODULO TIROIDEO IPERFUNZIONANTE

MIT: EVIDENZE DELLA LETTERATURA

ROBERTO CESAREO

LATINA

Progressively growing benign, thyroid lesions that reach to a volume over 12 ml seem to be especially suited for minimally invasive procedures.

Less appropriate indications are large nodular goitres, multinodular thyroid disease or deeply positioned lesions.

European Journal of Endocrinology (2014)

VOLUME 20X18X21 = 4,1 ml

VOLUME 2.8X2.8X3.2 = 13 ml

VOLUME THYROID NODULE

NODULO SMALL

NODULO MIDDLE

NODULO LARGE

VOLUME 46X34X46 = 37 ml

Nodulo small <12 ml

Nodulo Middle 12 e 30ml

Nodulo Large >30 ml

VOLUMETRIC CLASSIFICATION

For patients with toxic adenoma, the risk of

treatment failure is < 1% after surgical resection

(ipsilateral thyroid lobectomy or isthmusectomy)

The prevalence of hypothyroidism is 2.3% following

lobectomy for toxic adenoma

Postradioiodine hypothyroidism may develop in up to 60% after

20 years

However, radioiodine is not suited for large nodules that

require high doses of radioiodine and may be unresponsive to

treatment

ENDOCRINE PRACTICE 2010

Int J Endocrinol Metab. 2014

Patients with end-stage renal failure cannot excrete radioiodine normally

Breast feeding

Pregnancy

Drugs with a high iodine content (amiodarone, saturated solution of potassium iodide or radiocontrast media)

Claustrophobic patients

RADIOIODINE TREATMENT

Exclusion Criteria

THYROID 2017

Long-term ATD treatment is effective and safe, especially in adults,

indicating that it should be considered as an alternative treatment for

Graves’ disease.

LASER THERMAL ABLATION

RADIOFREQUENCY

MOVING SHOT AND HOOK UMBRELLA

ENDOCRINE PRACTICE Vol 22 No. 5 May 2016

ENDOCRINE PRACTICE Vol 22 No. 5 May 2016

Endocr Pract 2007

The total number of PLA sessions

ranged from 1 to 5 (median, 3)

Combined treatment determined faster volume reduction and relief of symptoms, and faster control of hyperthyroidism.

In group (LAT131I), however, normalization of TSH occurred in nine of 15 patients (60%) already 1 month after LAT; in particular, in three of these patients radioiodine was not necessary

J Clin Endocrinol Metab 2014

Int J Hypert 2017

Endocrine 2015

The patients that went into remission had their

nodules reduced on average by 81 %, as compared

to those that improved, which were reduced on average

by 68% after 12 months from the procedure

The mean number

of treatment session was

1.8 ± 0.9

(range, 1 - 6 sessions))

Thyroid 2015

Int J Hypert 2018

Int J Hyper2018

Scintigrafia_t0 scintigrafia_t24

hot coldDrop-

out hot cold

VOLUME NODULO

<1215 0 1 2 12

>1214 0 3 9 2

Int J Hypert 2018

Clin End 2019

UNDER REVISION 2019

Under Rev 2019

Under Rev 2019

Under Rev 2019

Under Rev 2019

Korean J Radiol 2018

Int J Hypert 2019

TAKE HOME MESSAGES

Strong evidences

⚫ Toxic or pre-toxic thyroid nodule < 5/10 ml

⚫ The patient refuses surgery or cannot do

surgery or RM treatment

⚫ THY-2 at citological examination

⚫ Nodule > 20 ml: what should we do?

⚫ Is it cost-effective to performe more

treatments?

⚫ More of these nodules are THY 3a:

What shall we do in this context?

TAKE HOME MESSAGES

Low evidences