Laser – eng

In cross sectional surveys worldwide, the prevalence of multinodular goiter has grown in the adult population, and the women to men ratio is of at least 4:1 [1]. In the Whickham survey, 16% of the cohort had palpable diffuse or multinodular goiters (MG) [2]. The natural history of multinodular goiter varies, goiter growth and function being difficult to predict in patients; 20% (or more) of the solid nodules appear to increase in size over time. [3]. The therapeutic strategies for euthyroid patients are clinical surveillance, L-Thyroxine  (L-T4) suppression therapy, percutaneous ethanol injection, and surgery, which is indicated in the following clinical situations: progressive growth of the entire goiter  or of individual nodules; compression of the trachea, esophagus, recurrent laryngeal nerve or cervical veins; and significant aesthetic disfigurement. L-T4 therapy has little or no effect on nodule size [4].

In 2002 Døssing H  et al. [6] and in 2004 Pacella CM et al  [7] introduced ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules. Our group in Perugia, after  a training with Doctors C. Pacella and E. Papini, started the procedure in 2005. The first results with ultrasound-guided laser photocoagulation by our group have been published in 2006 and were very promising [8]. For this reason, we implemented the technology and, actually, we are using a new generation Laser,a 1064nm continuous-wave neodymium yttrium-aluminum-garnet laser (Smart 1064, Elesta, Florence, Italy) combined with ultrasound guidance using a multifrequency probe (8-13MHz) (Esaote). In a recent study, we compared in terms of efficacy and safety different amounts of energy delivered for  percutaneous laser thermalnodule ablation [9].

The percutaneous laser thermal ablation of thyroid nodules is a viablealternative to traditional surgery since it is less invasive and, therefore, incurs fewer complications (possibly mild fever and local pain for a few hours). At present,on a case series of 500 nodules treated, our average rate of reduction of volume size of benign thyroid nodules is 62% (12 months after a single treatment) and recurrence or unsuccessful rates are less than 5%. The treatment is almost painlessand does not require sedation or anesthesia (see in the section “dicono di noi” a letter reporting the experience of a patient coming from Sidney, Australia).

It is possible for patients living outside of Italy to undergo to laser thermal ablationof thyroid nodules with anhalf day stay in the Clinica Liotti ( www.casadicuraliotti.it/), dell’Osteria, 1 – 06073 Taverne di Corciano (Perugia). The costs of the treatment is 2.400 euro, all included. Before the laser treatment it is necessary to have two recent cytological exams of the nodule which confirm that it is a benign tumor. For further information, please contact defeotiroide@gmail.com.

REFERENCES

1)    Hegedüs L. 2004 Clinical practice. The thyroid nodule. New Engl J Med351:1764-1771

2)    Tunbridge W.M., Evered D.C., Hall R., Appleton D., Brewis M., Clark F., Evans J.G., Young E., Bird T. &Smith PA 1977 The spectrum of thyroid disease in a community: The Whickham survey. ClinEndocrinol7 (6):481-493

3)    Alexander E.K., Hurwitz S., Heering J.P., Benson C.B., Frates M.C., Doubilet P.M., Cibas E.S., Larsen P.R. &Marqusee E. 2003 Natural history of benign solid and cystic thyroid nodules. Annals of Internal Medicine138:315-318

4)    Hegedüs L., Bonnema S.J. &Bennedbaek F.N. 2003 Management of simple nodular goiter: current status and future perspectives. Endocrine Reviews24:102-132

5)    Guglielmi R., Pacella C.M., Bianchini A., Bizzarri G., Rinaldi R., Graziano F.M., Petrucci L., Toscano V., Palma E., Poggi M. & Papini E. 2004 Percutaneousethanolinjection treatment in benignthyroidlesions. Role and efficacy. Thyroid14:125-31

6) Døssing H., Bennedbaek F.N., Karstrup S. &Hegedüs L. 2002 Benign solitary solid cold thyroid nodules: US-guided interstitial laser photocoagulation–initial experience. Radiology225(1):53-7.

7)    Pacella C.M., Bizzarri G., Spiezia S., Bianchini A., Guglielmi R., Crescenzi A., Pacella S., Toscano V. &  Papini E. 2004 Thyroidtissue: US-guidedpercutaneous laser thermalablation. Radiology232(1):272-280

8) Gambelunghe G., Fatone C., Ranchelli A., Fanelli C., Lucidi P., Cavaliere A., Avenia N., D’Ajello M., Santeusanio S, De Feo P.2006 A randomized controlled trial to evaluate the efficacy of ultrasound-guided laser photocoagulation for treatment of benign thyroid nodules. J EndocrinolInvest29(9): 23-26.

9) GiovanniGambelunghe, Raffaela Fede, Vittorio Bini, Massimo Monacelli, NicolaAvenia, Michele D’Ajello, Renato Colella, Giovanni Nasini and Pierpaolo De Feo. 2012. Ultrasound-guided interstitial laser ablation for thyroid nodules is  effective only at high total amounts of energy: results from a three‑year- pilot study. SurgicalInnovation

10) Pacella CM, Mauri G, Achille G, Barbaro D, Bizzarri G, De Feo P, Di Stasio E, Esposito R, Gambelunghe G, Misischi I, Raggiunti B, Rago T, Patelli GL, D’Este S, Vitti P, Papini E.

Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients.J ClinEndocrinolMetab. 2015 Oct;100(10):3903-10. doi: 10.1210/jc.2015-1964. Epub 2015 Aug 14.

11) Gambelunghe G, Bini V, Stefanetti E, Colella R, Monacelli M, Avenia N, De Feo P.

Thyroid nodule morphology affects the efficacy of ultrasound-guided interstitial laser ablation: a nested case-control study.Int J Hyperthermia. 2014 Nov;30(7):486-9. doi: 10.3109/02656736.2014.963701. Epub 2014 Oct 7.

12) Pacella CM, Mauri G, Cesareo R, Paqualini V, Cianni R, De Feo P, Gambelunghe G, Raggiunti B, Tina D, Deandrea M, Limone PP, Mormile A, Giusti M, Oddo S, Achille G, Di Stasio E, Misischi I, Papini E. A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis.  Int J Hyperthermia. 2017 Jun 12:1-9. doi: 10.1080/02656736.2017.1332395. [Epub ahead of print]

 13) Giovanni Gambelunghe, Elisa Stefanetti, Renato Colella, Massimo Monacelli, Nicola Avenia & Pierpaolo De Feo A single session of laser ablation for toxic thyroid nodules: three-year follow-up results International Journal of Hyperthermia Vol. 0, Iss. 0, 2018 https://doi.org/10.1080/02656736.2018.1437931