Treatment of benign cold thyroid nodules: A randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up
Treatment of benign cold thyroid nodules: A randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up
复制标题
DOI：
10.1089/thy.2006.0204
复制
发表时间：
2007-03-01
期刊：
影响因子：
6.6
通讯作者：
Pacella, Claudio M.
中科院分区：
文献类型：
--
作者：
Papini, Enrico;Guglielmi, Rinaldo;Pacella, Claudio M.
本研究的目的。目的比较超声引导下经皮激光消融术(PLA)与左旋甲状腺素(LT4)抑制治疗对冷性甲状腺结节的临床和超声改变。方法：将62例患者随机分成三组，分别为单组(第1组)、LT4组(第2组)和随访组(第3组)。入选标准：甲状腺功能正常、甲状腺结节>5毫升、细胞学检查为良性病变的患者。治疗：第1组：用1.064微米功率为3W的Y3W石榴石激光进行激光治疗10min，第2组：调整LT4剂量诱导促甲状腺激素抑制，第3组：不治疗。结果。I组术后6个月和12个月结节明显减少(增量体积：-42.7%+/-13.6%；p=0.001)。在33.3%的病例中发现>；50%的减少。在第2组，观察到无明显的结节缩小。局部症状改善率第1组为81.2%，第2组为13.3%，第3组为0.0%(p=0.001)。无并发症发生。结论。单用聚乳酸后，局部症状明显改善，体积明显缩小。聚乳酸的治疗效果优于LT4。随访与结节的生长和局部症状的进展有关。对于有症状的良性寒冷性甲状腺结节患者，应考虑将聚乳酸作为一种潜在的微创替代手术。
Aim of the study. To compare clinical and ultrasound (US) changes induced in cold thyroid nodules by US-guided percutaneous laser ablation (PLA) versus follow-up or levothyroxine (LT4) suppressive therapy. Methods: 62 patients randomly assigned to a single PLA (Group 1), LT4 (Group 2), or follow-up (Group 3). Entry criteria: euthyroid patients with a solid thyroid nodule > 5 mL and benign cytological findings. Treatment: Group 1: PLA was performed with a 1.064 mu m neodymium yttrium-aluminum-garnet laser with output power of 3 W for 10 minutes; Group 2: the LT4 dose was adjusted to induce thyrotropin suppression; Group 3: no treatment. Results. In Group I a significant nodule reduction was found 6 and 12 months after PLA (delta volume: -42.7 +/- 13.6%; p = 0.001). A reduction > 50% was found in 33.3% of cases. In Group 2 a nonsignificant nodule shrinkage was observed. A nonsignificant volume increase was observed in Group 3. Improvement of local symptoms was registered in 81.2% of patients in Group 1 vs. 13.3% in Group 2 and 0.0% in Group 3 (p = 0.001). No complications were noted. Conclusions. A single PLA induced significant volume reduction and improvement of local symptoms. PLA was more effective than LT4. Follow-up was associated with nodule growth and progression of local symptoms. PLA should be considered a potential mini-invasive alternative to surgery in symptomatic patients with benign cold thyroid nodules.