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. Design: 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 (131I) dose. Methods: ILP was performed under continuous ultrasound-guidance and with an output power of 2.5–3.5 W. 131I was given as a single dose based on thyroid volume and a 24-h thyroid 131I 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 131I 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 131I 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 131I group (P=0.06 between-group). Two patients in the 131I group developed hypothyroidism but no major side effects were seen. Conclusions: This first randomized study, comparing ILP with standard therapy, demonstrates that ILP and 131I therapy approximately halves thyroid nodule volume within 6 months; but in contrast to 131I, extranodular thyroid volume is unaffected by ILP and no patient developed hypothyroidism. Using the present design, ILP seems inferior to 131I therapy in normalization of serum TSH. The potential value of ILP as a non-surgical alternative to 131I needs further investigation.

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Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules – a randomised study

Acta Endocrinologica ◽

10.1530/eje.1.01865 ◽

2005 ◽

Vol 152 (3) ◽

pp. 341-345 ◽

Cited By ~ 85

Author(s):

Helle Døssing ◽

Finn Noe Bennedbæk ◽

Laszlo Hegedüs

Keyword(s):

Thyroid Nodule ◽

Thyroid Function ◽

Laser Photocoagulation ◽

Thyroid Nodules ◽

Control Group ◽

Randomised Study ◽

Interstitial Laser Photocoagulation ◽

Nodule Volume ◽

Interstitial Laser ◽

Cold Thyroid Nodules

Aim: To evaluate the efficacy of ultrasound (US)-guided interstitial laser photocoagulation (ILP) on thyroid function, nodule size and patient satisfaction in benign solitary solid cold thyroid nodules by comparing one ILP session with no treatment in a prospective randomised study. Materials and methods: Thirty euthyroid outpatients with a benign solitary solid and a scintigraphically cold thyroid nodule causing local discomfort were assigned to one session of ILP (n = 15) or observation (n = 15) and followed for 6 months. Thyroid nodule volume and total thyroid volume were assessed by US and thyroid function was determined by routine assays before and during follow-up. Pressure and cosmetic complaints before and at 6 months were evaluated on a visual analogue scale. ILP was performed under US guidance and with an output power of 2.5–3.5 W. Results: In the ILP group, the nodule volume decreased from 8.2 ml (6.1; 11.9) (median; quartiles) to 4.8 ml (3.0; 6.6) after 6 months (P = 0.001). The overall median reduction was 44% (37; 52), which correlated with a significant decrease in pressure symptoms as well as cosmetic complaints. In the control group, a non-significant increase in median nodule volume of 7% (0; 34) after 6 months was seen. No major side-effects were seen in the ILP group. There was no correlation between thermal energy deposition and nodule volume reduction. Thyroid function was unaltered throughout. Conclusion: US-guided ILP, given as a single treatment, resulted in a satisfactory clinical response in the majority of patients with a benign solitary solid cold thyroid nodule, and may become a clinically relevant alternative to surgery in selected patients.

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Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

Acta Endocrinologica ◽

10.1530/eje-11-0220 ◽

2011 ◽

Vol 165 (1) ◽

pp. 123-128 ◽

Cited By ~ 73

Author(s):

Helle Døssing ◽

Finn Noe Bennedbæk ◽

Laszlo Hegedüs

Keyword(s):

Thyroid Nodule ◽

Thyroid Function ◽

Thyroid Surgery ◽

Laser Photocoagulation ◽

Thyroid Nodules ◽

Interstitial Laser Photocoagulation ◽

Nodule Volume ◽

Interstitial Laser

AimTo evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules.Design and methodsA total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5–3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic complaints were evaluated on a visual analogue scale (0–10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12–114).ResultsThe overall median nodule volume decreased from 8.2 ml (range 2.0–25.9) to 4.1 ml (range 0.6–33.0; P<0.001) at the final evaluation, corresponding to a median reduction of 51% (range: −194 to 95%). This correlated with a significant decrease in pressure as well as cosmetic complaints. After 12--96 months (median 38 months) of ILP, 21 patients (29%) had thyroid surgery because of an unsatisfactory result. All had benign histology. Thyroid function was unaltered throughout and side effects were restricted to mild local pain.ConclusionUS-guided ILP results in a satisfactory long-term clinical response in the majority of patients with a benign solitary solid cold thyroid nodule. Further large-scale studies should aim at optimizing selection criteria for ILP, preferably in randomized studies.

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Reduction of Thyroid Nodule Volume by Levothyroxine and Iodine Alone and in Combination: A Randomized, Placebo-Controlled Trial

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-0356 ◽

2011 ◽

Vol 96 (9) ◽

pp. 2786-2795 ◽

Cited By ~ 41

Author(s):

M. Grussendorf ◽

C. Reiners ◽

R. Paschke ◽

K. Wegscheider

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Controlled Trial ◽

Thyroid Volume ◽

Nodular Goiter ◽

Target Range ◽

University Hospitals ◽

Double Blind ◽

End Point ◽

Nodule Volume

Abstract Context: Nodular goiter is common worldwide, but there is still debate over the medical treatment. Objective: The objective of the study was the measurement of the effect of a treatment with (nonsuppressive) T4, iodine, or a combination of both compared with placebo on volume of thyroid nodules and thyroid. Design: This was a multicenter, randomized, double-blind trial in patients with nodular goiter in Germany [LISA (Levothyroxin und Iodid in der Strumatherapie Als Mono-oder Kombinationstherapie) trial]. Setting: The study was conducted in outpatient clinics in university hospitals and regional hospitals and private practices. Participants: One thousand twenty-four consecutively screened and centrally randomized euthyroid patients aged 18–65 yr with one or more thyroid nodules (minimal diameter 10 mm) participated in the study. Intervention: Intervention included placebo, iodine (I), T4, or T4+I for 1 yr. T4 doses were adapted for a TSH target range of 0.2–0.8 mU/liter. Outcome Measures: The primary end point was percent volume reduction of all nodules measured by ultrasound, and the main secondary end point was a change in goiter volume. Results: Nodule volume reductions were −17.3% [95% confidence interval (CI) −24.8/−9.0%, P < 0.001] in the T4+I group, −7.3% (95% CI −15.0/+1.2%, P = 0.201) in the T4 group, and −4.0% (95% CI −11.4/+4.2%, P = 0.328) in the I group as compared with placebo. In direct comparison, the T4+I therapy was significantly superior to T4 (P = 0.018) or I (P = 0.003). Thyroid volume reductions were −7.9% (95% CI −11.8/−3.9%, P < 0.001), −5.2% (95% CI −8.7/−1.6%, P = 0.024) and −2.5% (95% CI −6.2/+1.4%, P = 0.207), respectively. The T4+I therapy was significantly superior to I (P = 0.034) but not to T4 (P = 0.190). Conclusion: In a region with a sufficient iodine supply, a 1-yr therapy with a combination of I and T4 with incomplete suppression of thyrotropin reduced thyroid nodule volume further than either component alone or placebo.

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Challenges in the functional diagnosis of thyroid nodules before surgery for TSH-producing pituitary adenoma

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0221 ◽

2021 ◽

Vol 2021 ◽

Author(s):

Keita Tatsushima ◽

Akira Takeshita ◽

Shuji Fukata ◽

Noriaki Fukuhara ◽

Mitsuo Yamaguchi-Okada ◽

...

Keyword(s):

Pituitary Adenoma ◽

Thyroid Hormone ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Thyroid Stimulating Hormone ◽

Somatostatin Analogue ◽

Postoperative Phase ◽

List Type ◽

Thyroid Scintigraphy ◽

Serum Tsh

Summary A 50-year-old woman with thyroid-stimulating hormone (TSH)-producing pituitary adenoma (TSHoma) was diagnosed due to symptoms of thyrotoxicosis. Preoperatively, she showed thyrotoxicosis with the syndrome of inappropriate secretion of TSH (SITSH) and had a 5 cm nodule in her thyroid gland. Octreotide was administered preoperatively, which helped lower her serum TSH level but not her thyroid hormone level. These findings were atypical for a patient with TSHoma. The TSHoma was completely resected, and the TSH level dropped below the sensitivity limit shortly after surgery. Interestingly, however, thyroid hormone levels remained high. A clear clue to the aetiology was provided by consecutive thyroid scintigraphy. Although preoperative thyroid scintigraphy did not show a hot nodule and the mass was thought to be a non-functional thyroid nodule, the nodule was found to be hot in the postoperative phase of TSH suppression. By focusing on the atypical postoperative course of the TSHoma, we were able to conclude that this was a case of TSHoma combined with an autonomously functioning thyroid nodule (AFTN). Learning points The diagnosis of autonomously functioning thyroid nodules (AFTNs) depends on suppressed serum TSH levels. If thyroid hormones are resistant to somatostatin analogue therapy or surgery for TSHoma, complications of AFTN as well as destructive thyroiditis need to be considered. It is important to revisit the basics when facing diagnostic difficulties and not to give up on understanding the pathology.

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Metabolic syndrome and its components are associated with increased thyroid volume and nodule prevalence in a mild-to-moderate iodine-deficient area

Acta Endocrinologica ◽

10.1530/eje-09-0410 ◽

2009 ◽

Vol 161 (4) ◽

pp. 599-605 ◽

Cited By ~ 96

Author(s):

Semra Ayturk ◽

Alptekin Gursoy ◽

Altug Kut ◽

Cuneyd Anil ◽

Asli Nar ◽

...

Keyword(s):

Metabolic Syndrome ◽

Thyroid Cancer ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Thyroid Volume ◽

Control Group ◽

Nodule Formation ◽

Model Assessment ◽

Increased Risk ◽

Deficient Area

ObjectiveMetabolic syndrome (MetS) is a cluster of metabolic abnormalities with insulin resistance (IR) as a major component. It has been recently questioned whether MetS and its related components are associated with functional and morphological alterations of the thyroid gland. The aim of our study is to examine thyroid volume and nodule prevalence in a case–control study of patients with MetS in a mild-to-moderate iodine-deficient area.DesignTwo hundred and seventy-eight patients with MetS were randomly matched for age, gender, and smoking habits with 261 subjects without MetS. Serum TSH, free tri-iodothyronine and thyroxine, and the level of IR, which was estimated by the homeostasis model assessment for IR, as well as other MetS parameters were evaluated. Thyroid ultrasonography was performed in all subjects. All subjects with thyroid nodules >1 cm were offered to undergo thyroid fine needle aspiration biopsy.ResultsTSH was significantly positively correlated with the presence of MetS diagnosis. There was no association between free thyroid hormone levels and MetS and its related components. Mean thyroid volume was significantly higher in patients with MetS than in controls (17.5±5.5 vs 12.2±4.2 ml, P<0.0001). Also the percentage of patients with thyroid nodules was significantly higher in patients with MetS (50.4 vs 14.6%, P<0.0001). Subjects were also divided into two groups according to the presence of IR. The group of subjects with IR had increased thyroid volume and nodule formation. The odds ratio for the development of thyroid nodule in the presence of IR was 3.2. TSH as well as all MetS components were found to be independent predictors for thyroid volume increase. IR but not TSH was found to be correlated with thyroid nodule formation. Thyroid cancer was diagnosed in 3 out of 38 patients with MetS who agreed to have a biopsy (7.9%). None of the subjects in the control group was diagnosed to have thyroid cancer.ConclusionsThe results suggest that patients with MetS have significantly increased thyroid volume and nodule prevalence. Multivariate regression analysis model demonstrated that the presence of IR contributed substantially to this increased risk. Our data provide the first evidence that IR is an independent risk factor for nodule formation in an iodine-deficient environment.

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Construction of a Nomogram Model to Predict The Risk of Hypothyroidism in Patients With Thyroid Nodule Caused by Environmental Iodine and Fluorine

10.21203/rs.3.rs-134775/v1 ◽

2020 ◽

Author(s):

Ruixia Yan ◽

Dongliang Yang ◽

Yanguo Li ◽

Yuan Zhou ◽

Yaxian Pang ◽

...

Keyword(s):

Risk Factors ◽

Drinking Water ◽

Logistic Regression ◽

Regression Analysis ◽

Thyroid Nodule ◽

Roc Curve ◽

Thyroid Nodules ◽

Water Fluoride ◽

Serum Tsh ◽

Urine Iodine

Abstract Background: Patients with thyroid nodules may be complicated by hypothyroidism. However, effective means to predict thyroid-stimulating hormone (TSH) elevation in patients with thyroid nodules are currently lacking. Therefore, the research team recruited some patients with thyroid nodules to explore the relationship between TSH, environmental iodine, and fluoride and the development of thyroid nodules, and to draw a Nomogram in order to provide guidance for predicting hypothyroidism in patients with thyroid nodules.Methods: The subjects were from 313 patients with thyroid nodules in different areas of iodine and fluoride, with 71 men and 242 women. The content of TSH in serum of thyroid nodule patients was determined by electrochemical luminescence method. The iodine content in drinking water and urine was determined by arsenic-cerium catalytic spectrophotometry. Fluoride in drinking water and urine was determined by fluoride ion selective electrode method. Univariate analysis, Lasso regression analysis and multiple factor Logistic regression analysis were used to screen the variables included in the Nomogram model. And the corresponding Nomogram model was constructed. ROC curve was drawn and repeated Bootstrap self-sampling method was used to test model differentiation.Results: There were 53 patients with elevated serum TSH and 256 patients with normal thyroid nodule. Multivariate logistic regression analysis shows that urine iodine（Odds Ratio[OR]=1.001, 95% confidence interval [95%CI]:1.001～1.002, P=0.01） and gender (OR=3.328, 95% CI:1.256～8.819, P=0.079) are independent risk factors raised by serum TSH. And drinking water fluoride（OR=1.990, 95% CI:0.924～4.289, P=0.079）is a critical factor. Based on these risk factors, the predictive model and nomogram of serum TSH elevation in patients with thyroid nodule were constructed. The area under the ROC curve was 0.678 (P<0.001), confirming Nomogram's predictive potential. The calibration diagram of the Nomogram prediction model shows that the predicted values are in good agreement with the observed values.Conclusion: Gender, urine iodine and drinking water fluoride of thyroid nodules are independent influencing factors for the rise of serum TSH. The Nomogram can become a predictive accuracy and differentiation.

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High occurrence of thyroid multinodularity and low occurrence of subclinical hypothyroidism among tobacco smokers in a large population study

Journal of Endocrinology ◽

10.1677/joe.0.1750571 ◽

2002 ◽

Vol 175 (3) ◽

pp. 571-576 ◽

Cited By ~ 47

Author(s):

N Knudsen ◽

I Bulow ◽

P Laurberg ◽

H Perrild ◽

L Ovesen ◽

...

Keyword(s):

Tobacco Smoking ◽

Multivariate Regression ◽

Regression Models ◽

Thyroid Nodules ◽

Large Population ◽

Thyroid Volume ◽

Thyroid Ultrasonography ◽

Blood Tests ◽

Serum Tsh ◽

Tsh Levels

Tobacco smoking increases the risk of goitre and Graves' disease, but the association with thyroid nodularity and hypothyroidism has not been settled. We investigated 4649 subjects from the general population with questionnaires, thyroid ultrasonography and blood tests. The results were analysed in multivariate regression models. Tobacco smoking was associated with an increased prevalence of thyroid multinodularity (odds ratio (OR) 1.9; 95% confidence interval (CI) 1.4-2.5), but not with increased prevalence of solitary thyroid nodules. The tendency was for a stronger association in the area with the most pronounced iodine deficiency (P for interaction=0.08). Lower levels of serum TSH were found among tobacco smokers (P<0.001), but this association disappeared when adjustment was made for thyroid nodularity and thyroid Volume. The prevalence of elevated TSH levels was markedly reduced among smokers (OR 0.47; 95% CI 0.33-0.67). No association was found between smoking and hyperthyroidism. The observed associations seem to be explainable by the blocking of iodine uptake and organification in the thyroid by thiocyanate, a degradation product of cyanide in tobacco smoke.

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Ultrasound-guided radiofrequency ablation (RFA) of benign symptomatic thyroid nodules – initial UK experience

British Journal of Radiology ◽

10.1259/bjr.20190026 ◽

2019 ◽

pp. 20190026

Author(s):

Susan Jawad ◽

Simon Morley ◽

Sofia Otero ◽

Timothy Beale ◽

Steven Bandula

Keyword(s):

Radiofrequency Ablation ◽

Thyroid Nodules ◽

Post Treatment ◽

Published Data ◽

Thyroid Function Tests ◽

Related Quality ◽

Autonomously Functioning Thyroid Nodules ◽

Nodule Volume ◽

Pre Treatment

Objective: To report on the use of RFA for the treatment of symptomatic benign and autonomously functioning thyroid nodules (AFTNs) in the first reported UK cohort. Methods: Patients treated over a 19-month period were retrospectively reviewed. Nodules were assessed pre-treatment and at 1 and 6 months post-treatment. Nodule volume was calculated and cosmetic assessment and thyroid-related quality of life (QoL) scores were recorded at each time point. Thyroid function tests (TFTs) were recorded at all three time points for patients with ATFNs. Results: 46 patients with 50 nodules were treated with no complications. The mean volume reduction 1-month post-treatment was 53 +- 14.9 % ( p < 0.0001). Six month data was available for 31 nodules and showed a mean 67 +- 17.6% vol reduction ( p < 0.0001). Five of the six patients with ATFNs were euthyroid at 1-month post-procedure. 6-month data was available on three of these patients, and all remained euthyroid. The thyroid-related QoL and cosmetic scores also improved. Data from 23 patients was available pre-treatment and at 6 months post-treatment and there was a significant ( p < 0.0001) reduction in QoL score. Pre-treatment, 82 % of nodules were readily visible at rest, decreasing to 12.5 % 6 months after treatment ( p < 0.0001). Conclusions: Results align with published data suggesting that RFA is effective at reducing nodule volume and at treating ATFNs and leads to improvement in thyroid-related QoL and cosmetic scores. Advances in knowledge: This early UK experience demonstrates that day-case radiofrequency ablation can provide safe and effective treatment of benign symptomatic thyroid nodules.

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TSH measurement is not an appropriate screening test for autonomous functioning thyroid nodules: a retrospective study of 368 patients

Acta Endocrinologica ◽

10.1530/eje-13-1003 ◽

2014 ◽

Vol 170 (4) ◽

pp. 593-599 ◽

Cited By ~ 22

Author(s):

Rayan Chami ◽

Rodrigo Moreno-Reyes ◽

Bernard Corvilain

Keyword(s):

Retrospective Study ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Screening Tool ◽

Needle Aspiration ◽

Aspiration Cytology ◽

Thyroid Scan ◽

Autonomous Functioning ◽

Needle Aspiration Cytology ◽

Serum Tsh

ObjectiveBased on the assumption that normal TSH concentration rules out the presence of autonomous functioning thyroid nodules (AFTNs), clinical guidelines on the management of thyroid nodules only recommend a thyroid scan if TSH concentration is subnormal. However, the proportion of AFTN presenting with a normal TSH is unknown. Our objective is therefore to determine the proportion of AFTNs with a normal TSH level to ascertain whether a normal TSH really rules out an AFTN.DesignRetrospective study on 368 patients with an AFTN.MethodsThyroid scans with a diagnosis of AFTN were reviewed retrospectively by one of us (R Moreno-Reyes), blinded to the clinical data. The diagnosis of solitary AFTN was confirmed in 368 patients. Among them, we selected 217 patients based on the absence of another thyroid nodule >10 mm, the absence of medical conditions able to interfere with thyroid function, and the completeness of the data.ResultsThe proportion of AFTNs with normal TSH was 49%. This proportion increased to 71% in patients for whom thyroid scan was performed in the workup of a thyroid nodule.ConclusionsOur data suggest that serum TSH is not an effective screening tool to diagnose AFTNs. Using ‘TSH-only’ screening, as recommended by the majority of guidelines, the diagnosis of AFTN would have been missed in 71% of our patients in the workup of a thyroid nodule. Thyroid scan remains the gold standard for detecting AFTN and should be considered before performing fine-needle aspiration cytology (FNAC), as the reliability of FNAC in an unsuspected AFTN remains unclear.

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Management of toxic multinodular goitre and toxic adenoma

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.3224 ◽

2011 ◽

pp. 508-511

Author(s):

Dagmar Führer ◽

John H Lazarus

Keyword(s):

Thyroid Hormones ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Thyroid Tissue ◽

Tsh Receptor ◽

Multinodular Goitre ◽

Toxic Adenoma ◽

Thyroid Autonomy ◽

Hot Nodule ◽

Autonomously Functioning Thyroid Nodules

Toxic adenoma and toxic multinodular goitre represent the clinically important presentations of thyroid autonomy. Thyroid autonomy is a condition where thyrocytes produce thyroid hormones independently of thyrotropin (TSH) and in the absence of TSH-receptor stimulating antibodies (TSAB). Toxic adenoma (TA) is a clinical term referring to a solitary autonomously functioning thyroid nodule. The autonomous properties of TA are best shown by radio-iodine or 99mTc imaging. The classic appearance of TA is that of circumscribed increased uptake with suppression of uptake in the surrounding extranodular thyroid tissue (‘hot’ nodule, Fig. 3.3.11.1). Toxic multinodular goitre (TMNG) is a heterogeneous disorder characterized by the presence of autonomously functioning thyroid nodules in a goitre with or without additional nodules. These additional nodules can show normal or decreased uptake (cold nodules) on scintiscan. TMNG constitutes the most frequent form of thyroid autonomy.

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