Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F
German Center for Thermoablation of Thyroid Nodules, University Hospital, Frankfurt am Main, Germany.
Department of Nuclear Medicine, University Hospital, Frankfurt am Main, Germany.
Rofo. 2015 Nov;187(11):1011-5. doi: 10.1055/s-0035-1553348. Epub 2015 Jul 22.
The aim of this study was to assess the effectiveness of high intensity focused ultrasound (HIFU) in reducing thyroid nodule volume while preserving thyroid function as measured by immunological response.
12 patients (9 females) whose average age was 56.9 years (37 - 81) were treated with HIFU in an ambulatory setting. All patients had a single benign thyroid nodule treated in one HIFU session. The median nodular outline volume (NOV) was 3.4 ml (range 0.6 - 5.0 ml). The therapeutic ultrasound probe (Echopulse(®) THC900 888-H) used works with a frequency of 3 MHz, reaching temperatures of 80 - 90° C and a mean output between 87.6 and 192.8 W. To assess possible effects of HIFU on thyroid function, serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobulin (hTg) and antibodies against thyroglobulin (TAbs), thyrotropin receptors (TRAbs) and thyroid peroxidase (TPOAbs) were measured at enrollment, 24-hours post-HIFU treatment and at 3-month follow-up.Pre- post thyroglobulin reduction was measured to evaluate the success of ablation and the nodular outline volume (NOV) was evaluated at baseline and the 3-month follow-up to assess effectiveness.
All measured hormone levels were within normal ranges and remained stable (p > 0.05). No clinically meaningful immune reaction was induced (p > 0.05). Thyroglobulin serum levels increased significantly at 24 hours after ablation (p < 0.05) and decreased significantly at the 3-month follow-up (p < 0.05), returning to pre-ablative levels. The median reduction in nodular outline volume (NOV) was 55 % (p < 0.05).
HIFU is a safe and effective alternative for treating benign thyroid nodules, while preserving thyroid function. Further investigations with multiple treatments should be conducted to evaluate whether additional treatments can achieve greater volume reduction.
本研究旨在评估高强度聚焦超声（HIFU）在减少甲状腺结节体积的同时，通过免疫反应测量来维持甲状腺功能的有效性。
12例患者（9例女性），平均年龄56.9岁（37 - 81岁），在门诊接受HIFU治疗。所有患者均有一个良性甲状腺结节，在一次HIFU治疗中进行处理。结节轮廓体积（NOV）中位数为3.4毫升（范围0.6 - 5.0毫升）。使用的治疗超声探头（Echopulse(®) THC900 888 - H）频率为3兆赫，温度可达80 - 90°C，平均输出功率在87.6至192.8瓦之间。为评估HIFU对甲状腺功能的可能影响，在入组时、HIFU治疗后24小时以及3个月随访时测量血清三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）、甲状腺球蛋白（hTg）以及抗甲状腺球蛋白抗体（TAbs）、促甲状腺激素受体抗体（TRAbs）和甲状腺过氧化物酶抗体（TPOAbs）水平。测量消融前后甲状腺球蛋白的减少情况以评估消融的成功与否，并在基线和3个月随访时评估结节轮廓体积（NOV）以评估有效性。
所有测量的激素水平均在正常范围内且保持稳定（p > 0.05）。未诱发具有临床意义的免疫反应（p > 0.05）。消融后24小时甲状腺球蛋白血清水平显著升高（p < 0.05），在3个月随访时显著降低（p < 0.05），恢复到消融前水平。结节轮廓体积（NOV）中位数减少55%（p < 0.05）。
HIFU是治疗良性甲状腺结节的一种安全有效的替代方法，同时可维持甲状腺功能。应进行多次治疗的进一步研究，以评估额外治疗是否能实现更大程度的体积缩小。
