title: Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules.
abstract: OBJECTIVE
  Interstitial laser photocoagulation (ILP) is a new therapeutic option for the ablation of non-functioning and hyper-functioning benign thyroid nodules. Amelioration of the ablation procedure currently allows treating large nodules. Aim of this study was to evaluate the therapeutic efficacy of ILP, performed according to a modified protocol of ablation, in patients with large functioning and non-functioning thyroid nodules and to identify the best parameters for predicting successful outcome in hyperthyroid patients.
  
  
  METHODS
  Fifty-one patients with non-functioning thyroid nodules (group 1) and 26 patients with hyperfunctioning thyroid nodules (group 2) were enrolled. All patients had a nodular volume ≥40 ml. Patients were addressed to 1-3 cycles of ILP. A cycle consisted of three ILP sessions, each lasting 5-10 minutes repeated at an interval of 1 month. After each cycle of ILP patients underwent thyroid evaluation.
  
  
  RESULTS
  A nodule volume reduction, expressed as percentage of the basal volume, significantly occurred in both groups (F = 190.4; P < 0.0001 for group 1 and F = 100.2; P < 0.0001 for group 2). Receiver-operator-characteristic (ROC) curves were constructed for: (i) percentage of volume reduction; (ii) difference in nodule volume; (iii) total amount of energy delivered expressed in Joule. ROC curves identified the percentage of volume reduction as the best parameter predicting a normalized serum TSH (area under the curve 0.962; P < 0.0001). Intraoperative complications consisted in: (i) mild pain occurring in five (6.5%) patients, (ii) vasovagal reaction in two (2.6%) patients, (iii) fever within 24 hours from ILP in five (6.5%) patients. No major complications including persistent pain, laringeal nerve dysfunction, hypoparathyroidism, pseudocystic transformation, and/or neck fascitis were observed.
  
  
  CONCLUSIONS
  ILP represents a valid alternative to surgery also for large benign thyroid nodules, both in terms of nodule size reduction and cure of hyperthyroidism (87% of cured patients after the last ILP cycle). ILP should not be limited to patients refusing or being ineligible for surgery and/or radioiodine.
authors.affiliation: Unit of Thyroid Diseases Villa Cinzia, Naples, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Amabile
authors.forename: Mario
authors.initials: M
authors.lastname: Rotondi
authors.forename: Barbara
authors.initials: B
authors.lastname: Pirali
authors.forename: Rosa
authors.initials: R
authors.lastname: Dionisio
authors.forename: Lucio
authors.initials: L
authors.lastname: Agozzino
authors.forename: Michele
authors.initials: M
authors.lastname: Lanza
authors.forename: Luciano
authors.initials: L
authors.lastname: Buonanno
authors.forename: Bruno
authors.initials: B
authors.lastname: Di Filippo
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Fonte
authors.forename: Luca
authors.initials: L
authors.lastname: Chiovato
mesh_terms: D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016606:Thyroid Nodule / Q000473:pathology / Q000601:surgery*