Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up.
OBJECTIVE
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.


METHODS
Group 1: PLA was performed with a 1.064 mum 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 1 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.
Papini
Enrico
E
Department of Endocrine, Metabolic and Digestive Diseases, Ospedale Regina Apostolorum, Rome, Italy. enrico.papini@fastwebnet.it
Guglielmi
Rinaldo
R
Bizzarri
Giancarlo
G
Graziano
Filomena
F
Bianchini
Antonio
A
Brufani
Claudia
C
Pacella
Sara
S
Valle
Dario
D
Pacella
Claudio M
CM
D000279:Administration, Cutaneous; D000328:Adult; D005260:Female; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011988:Receptors, Thyroid Hormone / Q000378:metabolism; D013961:Thyroid Gland / Q000187:drug effects / Q000503:physiopathology; D016606:Thyroid Nodule / Q000628:therapy*; D013972:Thyrotropin / Q000096:biosynthesis; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome
D011988:Receptors, Thyroid Hormone; D013972:Thyrotropin; D013974:Thyroxine