Department of Surgery, The University of Hong Kong, Hong Kong SAR, China.
Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Int J Hyperthermia. 2020;37(1):324-331. doi: 10.1080/02656736.2020.1747646.
Since it is unclear whether clinical parameters can independently predict the subsequent treatment response following high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules, we aimed to examine clinical factors that may independently predict 12-month efficacy after HIFU treatment. One hundred and forty patients who had single ablation were categorized into two groups, those with 12-month nodule shrinkage above the median (Group I, = 70) and with shrinkage below or equal to the median (Group II, = 70). Baseline characteristics, treatment parameters, percentage change in serum TSH, Free thyroxine (FT4) and thyroglobulin (Tg) from baseline to Day 4 and appearance of microbubbles (hyperechoic marks (HEMs)) during treatment were compared between groups. To determine independent factors, a multivariate analysis was done by logistic regression analysis. Baseline characteristics and treatment parameters were comparable between groups. However, on Day-4, group I had significantly lower serum TSH (0.49mIU/L vs. 0.84mIU/L, = 0.011) and higher FT4 (22.11 pmol/L vs. 18.47 pmol/L, = 0.008) than group II. The percentage change in TSH, FT4 and Tg were significantly greater in group I ( = 0.002, = 0.009 and = 0.001 respectively). The proportion of HEMs observed during treatment was also significantly higher in group I (42.69% vs. 31.72%, = 0.030). Among the significant factors, the percentage change in FT4 was the only independent factor for 12-month shrinkage (OR = 1.018, 95%CI =1.003-1.032, = 0.017). Percentage change in serum FT4 on post-treatment Day-4 was an independent blood parameter for the subsequent nodule shrinkage at 12 months. This finding could potentially facilitate the decision for earlier retreatment of treated nodules.
由于目前尚不清楚临床参数是否可以独立预测高强度聚焦超声（HIFU）消融良性甲状腺结节后的后续治疗反应，我们旨在研究可能独立预测 HIFU 治疗后 12 个月疗效的临床因素。140 名接受单次消融的患者被分为两组，12 个月结节缩小超过中位数的患者（组 I，n=70）和缩小低于或等于中位数的患者（组 II，n=70）。比较两组之间的基线特征、治疗参数、从基线到第 4 天的血清促甲状腺激素（TSH）、游离甲状腺素（FT4）和甲状腺球蛋白（Tg）变化百分比以及治疗期间出现的微泡（高回声标记（HEMs））。为了确定独立因素，进行了多变量逻辑回归分析。两组之间的基线特征和治疗参数无差异。然而，在第 4 天，组 I 的血清 TSH（0.49mIU/L 与 0.84mIU/L， = 0.011）和 FT4（22.11pmol/L 与 18.47pmol/L， = 0.008）明显低于组 II。组 I 的 TSH、FT4 和 Tg 的变化百分比明显更大（ = 0.002、 = 0.009 和 = 0.001）。组 I 中观察到的 HEMs 比例也明显更高（42.69%与 31.72%， = 0.030）。在显著因素中，FT4 的变化百分比是 12 个月内结节缩小的唯一独立因素（OR=1.018，95%CI=1.003-1.032， = 0.017）。治疗后第 4 天血清 FT4 的变化百分比是随后 12 个月结节缩小的独立血液参数。这一发现可能有助于决定早期对治疗结节进行再次治疗。
