a Department of Internal Medicine , Azienda Ospedaliero-Universitaria di Perugia , Perugia , Italy.
b Studio Tiroide Prof. De Feo , Perugia , Italy.
Int J Hyperthermia. 2018 Aug;34(5):631-635. doi: 10.1080/02656736.2018.1437931. Epub 2018 Feb 22.
To confirm the effectiveness of laser ablation on toxic nodules in a large population with three years of follow-up.
Between 2009 and 2014, we treated 82 patients with hyperthyroidism related to the presence of a toxic nodular goitre. Patients were pre-treated pharmacologically with methimazole prior to single session of laser ablation (LA) and then followed up every 3 months with FT4 and TSH blood tests as well as ultrasound examination of the nodules treated.
All patients responded to the treatment. The median nodule volume decreased from 12 ml (range 5-118 ml) to 5 ml (range 1.2-40 ml) after three years (p < 0.001). The percentage of patients who discontinued methimazole therapy was reduced by increasing the initial volume of the toxic nodule. In nodules with a volume less than 5 ml, all patients were able to suspend methimazole; this percentage was reduced to 90.2% in nodules with a volume between 5 and 15 ml, 61.1% in those with volume 15-25 ml and only 28.5% in nodules larger than 25 ml. We had no major complications but only moderate pain and fever in the evening, a few hours after ablation therapy in 10% of treated patients.
Single session of LA of toxic thyroid nodules is effective and safe, especially in nodules with a volume under 15 ml.
通过三年的随访，证实激光消融术对大样本毒性结节的有效性。
在 2009 年至 2014 年间，我们治疗了 82 例因毒性结节性甲状腺肿而患有甲亢的患者。患者在接受单次激光消融术（LA）治疗前先用甲巯咪唑进行预处理，然后每 3 个月通过 FT4 和 TSH 血液检查以及对治疗结节的超声检查进行随访。
所有患者均对治疗有反应。结节体积中位数从 12ml（范围 5-118ml）降至 3 年后的 5ml（范围 1.2-40ml）（p<0.001）。随着毒性结节初始体积的增加，停止甲巯咪唑治疗的患者比例降低。在体积小于 5ml 的结节中，所有患者均能停止使用甲巯咪唑；而在体积为 5-15ml 的结节中，这一比例降至 90.2%，在体积为 15-25ml 的结节中降至 61.1%，在体积大于 25ml 的结节中降至 28.5%。我们没有出现重大并发症，但只有 10%的治疗患者在消融治疗后数小时（晚上）出现中度疼痛和发热。
单次 LA 治疗毒性甲状腺结节是有效且安全的，尤其是结节体积小于 15ml 时。
