Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.
Laser Therapy* ; Thyroid Diseases* ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography

Objective: To compare levothyroxine alone and in combination with iodine on thyroid nodule volume reduction.

Methods:

Design:           Double-Blind Randomized Controlled Trial

Setting:           Tertiary Government Hospital

Participants: Nineteen (19) euthyroid patients age 19-54 with at least 1 cytologically benign thyroid nodule were randomized to receive either levothyroxine + iodine or levothyroxine + placebo, taken once a day for 6 months with ultrasound and thyroid stimulating hormone monitoring on the 3rd and 6th month of intervention.

Results: Main outcome measures included thyroid nodule volume reduction after six months of intervention. The mean change in volume from baseline to six months of levothyroxine + iodine group showed no statistically significant difference in nodule volume across time between  levothyroxine + placebo group, -0.010 ± 1.250 (CI -0.521 - 0.501) versus 0.507 ± 1.128 (CI 0.025 - 0.990), p=.158.  There were also new nodules (4 nodules) in the placebo group and none in the iodine group. No major adverse events were noted during the study.

Conclusion: The two groups did not significantly differ in terms of nodule volume reduction.

Keywords: thyroid nodule, prevention and control; drug therapy; iodine compounds, therapeutic use; levothyroxine, therapeutic use

While thyroid nodules have relatively low incidence in children and adolescents,they are at high risk of malignancy. In addition,the clinical manifestations,biological behaviors,assessment methods,indications of fine-needle aspiration,and treatment principles also differ from those in adults. In the past,the assessment,treatment,and follow-up of thyroid nodules in children and adolescents follow the guidelines for adult patients,which are actually not applicable for children and adolescents in the real-world clinical settings. Based on the latest international guidelines on the management of thyroid nodules and differentiated thyroid cancer,this article summarizes the clinical features,pathological characteristics,evaluation methods,treatments,and follow-up of thyroid cancer in children and adolescents.
Adolescent ; Biopsy, Fine-Needle ; Child ; Humans ; Thyroid Neoplasms ; diagnosis ; therapy ; Thyroid Nodule ; diagnosis ; therapy

Thermal ablation (TA) procedures, such as radiofrequency ablation and laser ablation, are used for the treatment of benign thyroid nodules. Short-term studies (<2 years) have demonstrated that TA is an effective and safe procedure to improve cosmetic or symptomatic problems. However, studies including a longer follow-up period show that treated thyroid nodules can increase in size after 2 to 3 years. Several studies suggest that this results from regrowth at the undertreated nodule margins. Here, we review current data on regrowth after TA and describe factors related to it and possible approaches to prevent it.
Catheter Ablation ; Follow-Up Studies ; Laser Therapy ; Thyroid Gland ; Thyroid Nodule

Female ; Humans ; Pregnancy ; Pregnancy Complications ; diagnosis ; therapy ; Thyroid Nodule ; diagnosis ; therapy

Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation.
*Catheter Ablation/methods ; Humans ; *Laser Therapy/methods ; Thyroid Nodule/*surgery/ultrasonography

Most thyroid nodules are cytologically benign and can be managed nonsurgically. Asymptomatic benign nodules require follow-up without treatment. Cosmetic problems and/or compression-related symptoms may be indications for treatment. Until now in clinical practices, nonsurgical image-guided therapy includes percutaneous ethanol injection, radiofrequency ablation, laser ablation, and high intensity focused ultrasound. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Radiofrequency ablation is an effective procedure for obtaining shrinkage and improving symptoms of solid thyroid nodules. Better understanding of image-guided therapy makes physicians personalize the management of benign thyroid nodules according to a cost-benefit analysis.
Catheter Ablation ; Cost-Benefit Analysis ; Ethanol ; Follow-Up Studies ; Humans ; Laser Therapy ; Thyroid Nodule* ; Ultrasonography

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Because papillary thyroid carcinoma (PTC) is indolent and has an excellent prognosis, active surveillance, without immediate surgery, can be considered for small PTC. However, rarely, PTC can transform to anaplastic thyroid carcinoma (ATC), over a period of 5-20 years. We report 73-year-old man with rapid anaplastic transformation of a PTC. He was diagnosed with colorectal cancer, and a 1-cm-sized thyroid nodule was found incidentally and confirmed as PTC on fine-needle aspiration. He underwent transanal excision and chemotherapy for colorectal cancer. However, he was not concerned about the PTC, and no follow-up examination was performed. After 37 months, he suddenly noticed an enlarging neck mass, which was diagnosed as an ATC. Despite total thyroidectomy, locally advanced recurrence with lung metastasis developed, and he eventually died. Although PTC is indolent and progresses slowly in elderly people, it can transform to ATC. Therefore, during active surveillance in the elderly, follow-up examinations should be performed regularly.
Aged ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Drug Therapy ; Follow-Up Studies* ; Humans ; Lung ; Neck ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Thyroid Carcinoma, Anaplastic ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

Simple aspiration is the initial therapy in patients with the symptomatic benign thyroid cystic nodule, but treatment failure is very common. In patients with recurrent cystic thyroid nodules, ethanol ablation (EA), radiofrequency ablation, or laser ablation can be used to prevent reaccumulation of cystic fluid. EA is simple, cheap and needs no specialized equipment. Kim et al. reported the long-term efficacy and safety of ultrasound-guided percutaneous EA for cystic or predominantly cystic thyroid nodules. They also evaluated the clinical factors associated with treatment failure. Successful ablation was obtained in 31 of 40 (77.5%) patients, and initial large cystic volume was the factor associated with therapeutic failure. The side effect was negligible except transient local pain immediately after the procedure. Although this study had retrospective design and irregular follow-up, it is plausible that EA is a safe and effective therapy for treating cystic or predominantly cystic thyroid nodule.
Catheter Ablation ; Ethanol* ; Follow-Up Studies ; Humans ; Laser Therapy ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Treatment Failure