RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous
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RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous Lobectomy. Eun Ju Ha 1 , Jung Hwan Baek 1 , Jeong Hyun Lee 1 , Jin Young Sung 2 , Jae Kyun Kim 3 , Young Kee Shong 4

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Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous Lobectomy

Eun Ju Ha1, Jung Hwan Baek1, Jeong Hyun Lee1, Jin Young Sung2,

Jae Kyun Kim3 ,Young Kee Shong4

1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center

2Department of Radiology, Thyroid Center, Daerim St. Mary’s Hospital

3Department of Radiology, Chung-Ang University College of Medicine

4Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

Previous lobectomy patients

Symptomatic benign thyroid nodule in the remaining thyroid gland

What would be the best treatment option for this patient?


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

Introduction

  • For patients with previous lobectomy

    • Surgical treatment

      • Risks of recurrent laryngeal nerve injury and hypoparathyroidism

      • Permanent hypothyroidism

Lefevre et al. 2007. Langenbecks Arch Surg 392:685-691

Rafferty et al. 2007. J Am Coll Surg 205:602-607

  • Non-surgical treatments(RF-, laser- and ethanol ablation)

    attractive treatment options that may preserve thyroid function

Monzani et al. 1997. Clin Endocrinol (Oxf) 46:9-15

Baek et al. AJR Am J Roentgenol 194:1137-1142

Papini et al. 2008. Curr Opin Endocrinol Diabetes Obes 15:434-439

Valcavi et al.2010.Thyroid 20:1253-1261


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

RF ablation

  • Regarding thyroid function,

    • Transient hyperthyroidism in a few patients

    • Permanent hypothyroidismin two patients: the reason was unclear

      Thyroid function seems to be rarely influenced by RF ablation

      but no studies in patients with previous lobectomy

Kim et al.2006.Thyroid 16:361-367

Jeong et al. 2008. Eur Radiol 18:1244-1250

Baek et al. 2012. Radiology 262:335-342


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

Purpose

To evaluate whether RF ablation for the treatment of benign

thyroid nodules affects thyroid function in patients with

previous lobectomy


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

7 patients

Hypothyroidism before RFA

  • predominantly solid nodule

  • pressure symptoms or cosmetic problems

  • cytologic confirmation of benignancy at least twice

  • no malignant features detected using US

  • refusal of surgery

Materials & Methods

Exclusion

4 patients

FU for less than 6-month

  • Inclusion criteria

2002.6-2009.12

22 patients of previous lobectomy due to benign thyroid nodules

Inclusion criteria

11 patients

with 14 thyroid nodules


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

Materials & Methods

  • The Procedure of RF ablation

    • By an experienced radiologist

    • Using the Cool-Tip RF system, Internally cooled electrode

    • Using the Moving shot technique

Baek et al. 2011 Korean J Radiol. 12:525-540

  • < Illustration for Moving Shot Technique>


Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

Materials & Methods

  • Pre-procedural evaluation

    • Clinical concern: symptomatic (0-10) / cosmetic (1-4) scores

    • US examination: the largest diameter, volume

    • Laboratory test: TSH, fT4, T3, anti-TPO/Tg/TSHRc Ab

  • Follow-up periods

    • Clinical concerns, US examination: 1-, 6-month, and last F/U

    • Laboratory test: 6-month, and last F/U

    • Complications


  • Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Materials & Methods

    • Statistical analysis

      • SPSS for Windows (version14.0; SPSS, Chicago, IL)

      • Compare the variables at the time of enrollment and the last F/U

        : Wilcoxon’s signed rank test


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Results

    • Follow-up duration : 43.7 ± 30.7 months

    • Interval (surgery- RF ablation):122.9 ± 151.3 months

    • Efficacy

    • VRR atlast follow-up :87.2%


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Results

    • Thyroid Function

    Each value is the mean ± SD, with the range in parenthesis

    • Thyroid Antibodies

    • None of the patients showed newly developed thyroid antibodies during the F/U


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Results

    92-month F/U


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Results

    • Complications :no major complicationsincluding voice change

    • None of the patients required additional surgery


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Case

    Improvement of symptomatic and

    cosmetic problems

    2 RF ablations


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Discussion ①

    • Thyroid function was well preserved in all patients

      The efficacy is usually confined to targeted nodules

      => damage to surrounding normal thyroid gland can be minimized


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Discussion ②

    Comparison with LA and EA

    Abbreviations:

    Tg: Thyroglobulin, TPO: Thyroid peroxidase, Ab: antibody

    NFTN: nonfunctioning thyroid nodule, AFTN: autonomously functioning thyroid nodule


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Discussion ②

    • The cause of hypothyroidism…

    Progression of autoimmune thyroiditis

    Treatment of autonomously functioning thyroid nodule (AFTN)

    • It may be necessary to warn the patients with thyroid antibodies

    • and the patients with AFTNsabout the possibility of

    • hypothyroidism prior to the treatment


    Eun ju ha 1 jung hwan baek 1 jeong hyun lee 1 jin young sung 2

    Conclusion

    • In patients with previous lobectomy,

      RF ablation

      has advantages in terms of maintaining thyroid function

      should be considered as a first-line treatment


    Thank you for your attention

    Thank you For Your ATtention


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