Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules
Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules
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DOI：
10.1007/s00268-009-0130-3
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发表时间：
2009-09-01
影响因子：
2.6
通讯作者：
Lee, Ducky
中科院分区：
文献类型：
--
作者：
Baek, Jung Hwan;Moon, Won-Jin;Lee, Ducky
一些自主功能性甲状腺结节（AFTN）患者不适合手术或放射性碘治疗。本研究包括9名不适合手术或放射性碘治疗的患者（4名中毒患者和5名中毒前患者;男女比例= 1：8;平均年龄47 ± 17（范围，25-71）岁）。99 mTc-高锝酸盐甲状腺显像均表现为热结节伴正常甲状腺抑制。使用17和18号内冷电极进行RFA。在治疗前和随访1、3、6个月时，对患者的结节体积、甲状腺功能、甲状腺造影、症状评分（视觉模拟评分，0-10 cm）、美容分级评分（4分制）和并发症进行评价。RFA后1个月时降低（12.01 +/- A 25.97 mL，p = 0.015）、3个月（7.27 +/- A 15.13 mL，p = 0.011）、6个月（8.27 +/- A 21.29 mL，p = 0.008）和最后一个月（7.57 +/- A 19.99 mL，p = 0.008）。初始平均T3、fT 4和TSH分别为156.2 +/- A 42.1 ng/dL、1.73 +/- A 0.40 ng/dL和0.052 +/- A 0.087 mU/mL。末次随访时观察到平均T3、fT 4和TSH显著改善（T3：116.8 +/- A 20.7 ng/dL，p = 0.015; fT 4：1.37 +/- A 0.26 ng/dL，p = 0.036; TSH：1.454 +/- A 1.756 mU/mL，p = 0.012）。消融后，4例患者变为冷或正常扫描，5例仍为热结节。平均症状和外观分级评分分别从2.4 +/- A 1.7降至0.6 +/- A 0.7（p = 0.011）和从3.1 +/- A 1.2降至1.4 +/- A 1.0（p = 0.017）。RFA治疗AFTN安全有效，无严重并发症。
Some patients with autonomously functioning thyroid nodules (AFTN) are not suitable for surgery or radioiodine therapy. Therefore, minimally invasive alternative treatments, such as ethanol ablation or radiofrequency ablation (RFA), are necessary.This study included nine patients (4 toxic and 5 pretoxic patients; male to female ratio = 1:8; mean age, 47 +/- A 17 (range, 25-71) years) who were not eligible for surgery or radioiodine therapy. All of the patients showed hot nodule with suppression of normal thyroid gland in Tc-99m pertechnetate scintigraphy. RFA was performed using a 17- and 18-gauge internally cooled electrode. Nodule volume, thyroid function, scintigraphy, symptom score (visual analogue scale, 0-10 cm), cosmetic grading score (4-point scale), and complications were evaluated before treatment and at 1, 3, and 6 months follow-up.Mean volume of the index nodule was 14.98 +/- A 25.53 (range, 0.29-82.29) mL. After RFA it decreased at 1 month (12.01 +/- A 25.97 mL, p = 0.015), 3 months (7.27 +/- A 15.13 mL, p = 0.011), 6 months (8.27 +/- A 21.29 mL, p = 0.008), and the last month (7.57 +/- A 19.99 mL, p = 0.008). Initial mean T3, fT4, and TSH were 156.2 +/- A 42.1 ng/dL, 1.73 +/- A 0.40 ng/dL, and 0.052 +/- A 0.087 mU/mL, respectively. A significant improvement of mean T3, fT4, and TSH were observed at last follow-up (T3: 116.8 +/- A 20.7 ng/dL, p = 0.015; fT4: 1.37 +/- A 0.26 ng/dL, p = 0.036; TSH: 1.454 +/- A 1.756 mU/mL, p = 0.012). After ablation, four patients became a cold or normal scan and five remained as a hot nodule. The mean symptom and cosmetic grading score was reduced from 2.4 +/- A 1.7 to 0.6 +/- A 0.7 (p = 0.011) and from 3.1 +/- A 1.2 to 1.4 +/- A 1.0 (p = 0.017), respectively. No major complications were encountered.RFA seems to be effective and safe for the treatment of AFTN.