Thursday, September 29, 2005

Laser Thermocoagulation of Benign Solid Thyroid Nodules: A New Therapy

We now put alcohol into recurrent cysts, as an alternative to surgery. Now there are studies published in Clinical Thyroidology 2003;15:11 on the effective use of another form of destruction of thyroid tissue. The use of a laser to "cook" the inside of solid FNA proven benign nodules that cause local symptoms in the neck, or appearance issues. Randomly assigned 30 females to Laser or no therapy for six months. The method involves Ultrasound Guided 18 G needle into the nodule.Then a o.4 mm wire is inserted into the center of the nodule.The needle is withdrawn.Then 2.5-3.0 W output power is given to the nodule. Vapor is seen in the area of the wire on ultrasound, and the area becomes hypoechoic. Two more 2.5-3.0 W outputs complete the therapy, for a total median energy of 2007 J.

The results:
The median volume decreased from 8.2 to 4.8 ml, while the volume increased from 7.5 to 9.0 ml in the untreated patients. A 44% reduction. The controls increased 9 %. There was a 53% difference between the two groups at 6 months. 7/15 in the laser group had neck pain, or tenderness for up to seven days. However, all would have the therapy again if needed. No serious complications occurred, such as vocal cord paralysis. 13/15 laser group patients had pressure symptoms before, and 10/13 had marked relief after the therapy. Cosmetic symptoms also decreased. There was no change in symptoms in the control group, even though the size increased an average of 9%.

Hegedus et al Eur J Endocrol 2005; 152:341-5

Dr Robert Utiger, editor of Clinical thyroidology, states that this seems to be a reasonable way to reduce nodules.
Even though the nodules did not disappear, they decreased enough to reduce symptoms and appearance problems. Usually symptomatic nodules were referred to surgery, but now this is a reasonable alternative.

Clinical thyroidologists will be offering this in the near future. Check to see if any are offering this now.


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