Miriam E Tucker

May 16, 2015

Nashville, Tennessee — Ultrasound-guided laser-ablation therapy (LAT) of benign thyroid nodules was effective and well-tolerated in the first large multicenter study to assess the technique in a real-world setting.

Findings from a retrospective analysis of data for 1534 consecutive laser-treated nodules in 1531 patients from nine Italian thyroid referral centers were presented May 15, 2015 in a late-breaker session here at the American Association of Clinical Endocrinologists' 2015 Annual Scientific and Clinical Congress by Dr Enrico Papini, from Sapienza University of Rome Medical School, Italy.

Previous randomized controlled studies of the minimally invasive procedure showed benefit in patients with growing or symptomatic nodules, but those studies all involved selected patients, single treatments, and fixed modalities of treatment.

This study looked at a large consecutive series of unselected benign thyroid nodules with variable structures, Dr Papini explained.

"In real practice this technique can be performed in outpatient settings," he said.

Minimally invasive techniques for treating benign and malignant thyroid nodules are only now beginning to be used by some tertiary centers in the United States, but as yet laser-ablation therapy has not been used here.

These latest data and others suggest that laser-ablation therapy should be adopted here by experienced endocrine surgery teams, Hossein Gharib, MD, from the Mayo Clinic, Rochester, Minnesota, and president-elect of the American Thyroid Association, told Medscape Medical News in an interview.

"We know it's effective. I think this is a positive step forward," said Dr Gharib, who, along with Dr Papini and others, recently published a review of nonsurgical image-guided minimally invasive approaches, including laser-ablation therapy, percutaneous ethanol-injection therapy, and radiofrequency ablation as alternatives to surgery for treating symptomatic thyroid nodules (J Clin Endocrinol Metab. 2013;98:3949-3957).

Some US tertiary centers, including the Mayo Clinic, have started to use the latter two minimally invasive approaches for thyroid disease, particularly in patients who either don't want surgery or who are not good surgical candidates. "There are certainly some centers that could develop laser-ablation therapy and offer it to patients with these problems," Dr Gharib observed.

Better Results in Complex Nodules

Dr Papini noted that inclusion criteria for the study were solid or mixed nodules with fluid components of up to 40%, benign cytological findings, and normal thyroid function.

Treatments included one to three illuminations with a fixed output power of 3 W, using the pullback technique.

The overall mean percentage volume reduction at 12 months was 68.1% (from 27.2 mL at baseline to 8.8 mL, P ˂.001). The reduction was much greater for nodules with a fluid component (mixed nodules) because the fluid component was drained just before laser firing. For these, there was a 79% volume reduction, from 12.2 mL at baseline to 2.4 mL (P ˂.001).

Symptoms decreased from 49% affected before the procedure to 10% afterward (P ˂.001), and evidence of cosmetic signs dropped from 86% to 8% (P ˂.001).

Major complications were rare, occurring in just 0.90% of patients. Of those, 48% were major dysphonia and 52% minor skin burns or hematoma. Moderate pain was reported in 1.9%, and severe pain in 0.2% of patients. When vocal-cord issues did occur, they resolved spontaneously after 2 to 84 days, Dr Papini said.

There were no hospitalizations, no changes in normal thyroid function, and no autoimmunity.

Dr Gharib told Medscape Medical News that in experienced thyroid-surgery centers, "I would definitely encourage this. We should promote it and develop it. I think some centers should develop an interest and expertise so we can have patient referrals.…I would certainly encourage my colleagues to do this."

Dr Papini and Dr Gharib have no relevant financial relationships.

American Association of Clinical Endocrinologists' 2015 Annual Scientific and Clinical Congress; May 15, 2015; Nashville, Tennessee. Abstract 1260.


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