Chianelli M, Bizzarri G, Todino V, Misischi I, Bianchini A, Graziano F, Guglielmi R, Pacella C M, Gharib H, Papini E
Endocrinology Unit (M.C., I.M., F.G., R.G., E.P.), Nuclear Medicine Unit (V.T.), and Interventional Radiology, Department Of Diagnostic Imaging (G.B., A.B., C.M.P.), Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy; and Endocrinology Division (H.G.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905.
J Clin Endocrinol Metab. 2014 Jul;99(7):E1283-6. doi: 10.1210/jc.2013-2967. Epub 2014 Mar 31.
It is normally recognized that the preferred treatment in large toxic thyroid nodules should be thyroidectomy.
The aim of the study was to assess the efficacy of combined laser ablation treatment (LAT) and radioiodine 131 (131I) treatment of large thyroid toxic nodules with respect to rapidity of control of local symptoms, of hyperthyroidism, and of reduction of administered 131I activity in patients at refusal or with contraindications to surgery.
We conducted a pilot study at a single center specializing in thyroid care.
Fifteen patients were treated with LAT, followed by 131I (group A), and a series of matched consecutive patients were treated by 131I only (group B).
INTERVENTION(S): Laser energy was delivered with an output power of 3 W (1800 J per fiber per treatment) through two 75-mm, 21-gauge spinal needles. Radioiodine activity was calculated to deliver 200 Gy to the hyperfunctioning nodule.
MAIN OUTCOME MEASURE(S): Thyroid function, thyroid peroxidase antibody, thyroglobulin antibody, ultrasound, and local symptoms were measured at baseline and up to 24 months.
Nodule volume reduction at 24 months was: 71.3 ± 13.4 vs 47.4 ± 5.5%, group A (LAT+131I) vs group B (131I), respectively; P < .001). In group A (LAT+131I), a reduction in radioiodine-administered activity was obtained (-21.1 ± 8.1%). Local symptom score demonstrated a more rapid reduction in group A (LAT+131I). In three cases, no 131I treatment was needed after LAT.
In this pilot study, combined LAT/131I treatment induced faster and greater improvement of local and systemic symptoms compared to 131I only. This approach seems a possible alternative to thyroidectomy in patients at refusal of surgery.
通常认为，大型毒性甲状腺结节的首选治疗方法应为甲状腺切除术。
本研究旨在评估联合激光消融治疗（LAT）和放射性碘131（131I）治疗大型毒性甲状腺结节在控制局部症状、甲亢以及减少拒绝手术或有手术禁忌证患者的131I给药剂量方面的疗效。
我们在一家专门从事甲状腺治疗的单一中心进行了一项试点研究。
15例患者接受了LAT治疗，随后接受131I治疗（A组），一系列匹配的连续患者仅接受131I治疗（B组）。
通过两根75毫米、21号的脊椎穿刺针以3瓦的输出功率输送激光能量（每次治疗每根光纤1800焦耳）。计算放射性碘剂量，以使功能亢进结节接受200戈瑞的辐射。
在基线时以及长达24个月的时间内测量甲状腺功能、甲状腺过氧化物酶抗体、甲状腺球蛋白抗体、超声检查以及局部症状。
24个月时结节体积缩小情况分别为：A组（LAT + 131I）为71.3 ± 13.4%，B组（131I）为47.4 ± 5.5%；P < .001）。在A组（LAT + 131I）中，可以减少放射性碘给药剂量（-21.1 ± 8.1%）。局部症状评分显示A组（LAT + 131I）改善更快。有3例患者在LAT治疗后无需进行131I治疗。
在这项试点研究中，与仅使用131I治疗相比，联合LAT/131I治疗能更快、更显著地改善局部和全身症状。对于拒绝手术的患者，这种方法似乎是甲状腺切除术的一种可能替代方案。
