Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules.
OBJECTIVE
To compare the efficacy of interstitial laser photocoagulation (ILP) with radioiodine in hot thyroid nodules.


METHODS
Thirty consecutive outpatients with subclinical or mild hyperthyroidism and a scintigraphically solitary hot nodule with extraglandular suppression were randomized to either one ILP session or one radioiodine ((131)I) dose.


METHODS
ILP was performed under continuous ultrasound-guidance and with an output power of 2.5-3.5 W. (131)I was given as a single dose based on thyroid volume and a 24-h thyroid (131)I uptake. Thyroid function and nodule volume were evaluated at inclusion and at 1, 3 and 6 months after treatment.


RESULTS
Normalization of serum TSH was achieved in 7 out of 14 patients in the ILP group and in all 15 patients in the (131)I group (P=0.0025). In the ILP group, mean thyroid nodule volume reduction was 44+/-5% (s.e.m.; P<0.001), and in the (131)I group 47+/-8% (P<0.001), within 6 months, without between-group difference (P=0.73). The mean reduction of total thyroid volume was 7+/-5% in the ILP group (P=0.20) and 26+/-8% (P=0.006) in the (131)I group (P=0.06 between-group). Two patients in the (131)I group developed hypothyroidism but no major side effects were seen.


CONCLUSIONS
This first randomized study, comparing ILP with standard therapy, demonstrates that ILP and (131)I therapy approximately halves thyroid nodule volume within 6 months; but in contrast to (131)I, extranodular thyroid volume is unaffected by ILP and no patient developed hypothyroidism. Using the present design, ILP seems inferior to (131)I therapy in normalization of serum TSH. The potential value of ILP as a non-surgical alternative to (131)I needs further investigation.
Døssing
Helle
H
Department of Oto-Rhino-Laryngology and Neck Surgery, Odense University Hospital, DK-5000 Odense C, Denmark. helle.doessing@ouh.fyns-amt.dk
Bennedbaek
Finn Noe
FN
Bonnema
Steen Joop
SJ
Grupe
Peter
P
Hegedüs
Laszlo
L
D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000528:radiation effects; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D025321:Surgery, Computer-Assisted / Q000379:methods; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000473:pathology; D016606:Thyroid Nodule / Q000473:pathology / Q000503:physiopathology* / Q000532:radiotherapy*; D018084:Ultrasonography, Interventional / Q000379:methods
D007457:Iodine Radioisotopes