Hiệu quả bước đầu điều trị nhân nóng tuyến giáp bằng phương pháp đốt sóng cao tần

Initial effectiveness of radiofrequency ablation of the autonomously functioning thyroid nodules

SUMMARY

Objective: Some patients with autonomously functioning thyroid nodules (AFTN) are not suitable for surgery or radioiodine therapy. Therefore, minimally invasive alternative treatments, such as ethanol ablation or radiofrequency ablation (RFA), are necessary.

Methods: This study included seven patients (7 toxic and 10 pretoxic patients; male to female ratio = 1:7.5; mean age, 46.47 ± 13 (range, 22–66) years) who were not eligible for surgery or radioiodine therapy. All of the patients showed hot nodule with suppression of normal thyroid gland in 99mTc pertechnetate scintigraphy. RFA was performed using a 18 gauge internally cooled electrode. Nodule volume, thyroid function, scintigraphy, symptom score (visual analogue scale, 0–10cm), cosmetic grading score (4 point scale), and complications were evaluated before treatment and at 1, 3, 6 months follow-up.

Results: Mean volume of the index nodule was 13.07 ± 8.44 (range, 2.2–35.5) mL. After RFA, The volume reduction at 1month, 3 months, 6 months follow up was 42.77 % , 63. % và 78.3 % . Initial mean T3, FT4, and TSH were 2.59 ± 1.19nmol/L, 16.3 ± 5.78pmol/L, and 0.101 ± 0.178 mU/mL, respectively. A significant improvement of mean T3, FT4, and TSH were observed after 1month (T3: 2.18 ± 0.753 nmol/L, p = 0.001; FT4: 14.78 ± 2.86 pmol/L, p = 0.026; TSH: 1.464 ± 0.844 mU/mL, p = 0.001), after 6 months (T3: 2.07 ± 0.614 nmol/L, p = 0.012; FT4: 15.12 ± 2.0 pmol/L, p = 0.001; TSH: 1.269 ± 0.398 mU/ mL, p < 0.001). After ablation, 16 patients became a cold or normal scan and one patient uptake similar normal thyroid tissue. After 6 months, the mean symptom was reduced from 3.47 ± 1.9 to 0.12± 3.32 (p = 0.001) and cosmetic grading score was reduced from từ 3.59 ± 1.1 tới 1.41± 0.712 (p = 0.712) (p <0.001). No major complications were encountered.

Conclusions: RFA was effective and safe for treating autonomously functioning benign thyroid nodules and it might be recommended for treating hot benign thyroid nodules as the first-line treatment