scholarly journals Minimally Invasive Radiofrequency Ablation for Large Thyroid Toxic Adenoma

2019 ◽  
Vol 46 (3) ◽  
pp. 50-52
Author(s):  
M. Belitova ◽  
S. Ivanov ◽  
Ts. Marinov ◽  
T. Popov ◽  
R. Pandev
Keyword(s):  
Radiofrequency Ablation ◽  
Treatment Option ◽  
Multinodular Goiter ◽  
Thyroid Nodules ◽  
Percutaneous Treatment ◽  
Thyroid Stimulating Hormone ◽  
Treatment Modalities ◽  
Toxic Adenoma ◽  
Effective Treatment Option ◽  
Thyroid Lobectomy

Abstract Background: Most thyroid nodules are benign and do not need intervention. Toxic adenoma and toxic multinodular goiter (MNG) are common causes of hyperthyroidism, second in prevalence only to Graves’ disease. Toxic adenoma and MNG are the result of focal or diffuse hyperplasia of thyroid follicular cells whose functional capacity is independent from regulation by the thyroid stimulating hormone (TSH). When conservative treatment modalities fail to ensure an euthyroid state, surgical intervention is required, typically surgical left or right thyroid lobectomy. Radiofrequency ablation (RFA) is a new percutaneous treatment option that results in thermal tissue necrosis and fibrosis. As a result of this process, the thyroid nodules shrink. Case presentation: We describe a case of a young woman with a large toxic thyroid adenoma who refused surgery. She was admitted to a one-day surgery unit and underwent radiofrequency ablation under total intravenous anesthesia. Using “moving shot technique” the procedure went uneventfully and the toxic adenoma displayed a significant volume reduction with resolution of the hyperthyroid symptoms. The patient also reported a significant improvement of her neck symptoms (from 7/10 to 1/10 on a Visual Analogue Scale). Conclusions: Radiofrequency ablation is a new, well tolerated, safe and effective treatment option in selected patients with benign thyroid nodules, toxic adenomas of the thyroid gland and multinodular goiter. To the best of our knowledge, this is the first time such treatment modality is used in Bulgaria.

scholarly journals Efficacy and safety of radiofrequency ablation for benign thyroid nodules in patients with previous thyroid lobectomy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lin Yan ◽  
Mingbo Zhang ◽  
Fang Xie ◽  
Jun Ma ◽  
Jing Xiao ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Symptom Score ◽  
Thyroid Function ◽  
Thyroid Nodules ◽  
Efficacy And Safety ◽  
Thyroid Lobectomy ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract Background Radiofrequency ablation (RFA) is recommended for the treatment of benign thyroid nodules. However, data on the clinical role of RFA for benign thyroid nodules in patients with history of thyroid lobectomy are insufficient. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign thyroid nodules in patients who had previously undergoing thyroid lobectomy. Methods From May 2015 to October 2018, a total of 20 patients (19 females, 1 male, mean age 49.50 ± 14.26 years, range 22–74 years) with 20 benign thyroid nodules (mean volume 15.04 ± 21.17 ml, range 0.40–69.67 ml) who had undergone previous thyroid lobectomy were included in this retrospective study. Patients were followed up at 3, 6, 12 months after RFA and every 12 months thereafter by ultrasound, clinical evaluation and thyroid function. Volume, volume reduction rate (VRR), symptom score and cosmetic score were evaluated. Results During the mean follow-up time of 21.24 ± 16.41 months, the mean nodule volume decreased significantly from 15.04 ± 21.17 ml to 1.29 ± 1.17 ml (P = 0.018) with a mean VRR of 85.41 ± 12.17%. Therapeutic success was achieved in a single session for all thyroid nodules. The symptom score (P = 0.001) and cosmetic score (P = 0.001) were both significantly reduced at the last follow-up. The levels of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone were not significantly different at the last follow-up from those prior to treatment (all P > 0.05). No life-threatening complications or sequelae occurred after RFA. Conclusions As a minimally invasive modality, RFA was a safe, effective, and thyroid function-preserving option for patients with symptomatic benign thyroid nodules after a previous lobectomy.

scholarly journals Percutaneous treatment of complex biliary stone disease using endourological technique and literature review

2015 ◽  
Vol 13 (4) ◽  
pp. 611-614 ◽  
Author(s):  
Fernando Korkes ◽  
Ariê Carneiro ◽  
Felipe Nasser ◽  
Breno Boueri Affonso ◽  
Francisco Leonardo Galastri ◽  
...  
Keyword(s):  
Literature Review ◽  
Treatment Option ◽  
Multidisciplinary Approach ◽  
Percutaneous Treatment ◽  
Extensive Literature ◽  
Hybrid Technique ◽  
Effective Treatment Option ◽  
Biliary Stone ◽  
Intrahepatic Stones ◽  
Special Cases

Most biliary stone diseases need to be treated surgically. However, in special cases that traditional biliary tract endoscopic access is not allowed, a multidisciplinary approach using hybrid technique with urologic instrumental constitute a treatment option. We report a case of a patient with complex intrahepatic stones who previously underwent unsuccessful conventional approaches, and who symptoms resolved after treatment with hybrid technique using an endourologic technology. We conducted an extensive literature review until October 2012 of manuscripts indexed in PubMed on the treatment of complex gallstones with hybrid technique. The multidisciplinary approach with hybrid technique using endourologic instrumental represents a safe and effective treatment option for patients with complex biliary stone who cannot conduct treatment with conventional methods.

scholarly journals Partial Enteral Nutrition in Crohn’s Disease

2021 ◽  
Author(s):  
Evgen Benedik ◽  
Darja Urlep ◽  
Anija Orel ◽  
Rok Orel
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Treatment Option ◽  
Paediatric Population ◽  
Treatment Modalities ◽  
Effective Treatment Option ◽  
Exclusive Enteral Nutrition ◽  
Randomised Controlled

Exclusive enteral nutrition (EEN) has proven to be a highly effective treatment option in inducing remission in active Crohn’s disease (CD) in the paediatric population. In adults with CD, the results of meta-analyses demonstrated that therapy with corticosteroids was more effective in comparison with EEN. The most important limitation of the success of EEN treatment is patients’ compliance. Exclusivity of enteral nutrition and its substantial impact on the quality of life are the main reasons why EEN is not acceptable to many patients. Therefore, the treatment with partial enteral nutrition (PEN), where patients are allowed to eat some ordinary food besides enteral formulas, is becoming an important treatment option, not only in inducing, but also in maintaining remission in CD. However, strong evidence on the efficacy of PEN for induction and maintenance of CD remission is still lacking. Due to the excellent safety profile of the treatment with enteral nutrition in comparison with other treatment modalities, further well-designed, randomised, controlled studies are necessary to elucidate the exact role of PEN in inducing and maintaining of remission in CD patients. Herein, the most relevant studies on the efficacy and the role of PEN in active and quiescent CD are reviewed.

scholarly journals Thyroglobulin as a possible predictor of doses radioiodine therapy in hyperthyroidism

2018 ◽  
Vol 48 (1-2) ◽  
Author(s):  
Salih Azabagić
Keyword(s):  
Multinodular Goiter ◽  
Radioiodine Therapy ◽  
Cost Effective ◽  
Antithyroid Drugs ◽  
Toxic Adenoma ◽  
Effective Treatment Option ◽  
Average Value ◽  
Cost Effective Treatment ◽  
Toxic Multinodular Goiter

Introduction According to guidelines for the management of hyperthyroidism, patients with hyperthyroidism should be treated with radioactive iodine, antithyroid drugs, or thyroidectomy. Oral administration of radioiodine is a safe and cost effective treatment option for patients with toxic multinodular goiter (TMG)/toxic adenoma (TA) or Grave’s disease (GD). The aim of the study was to evaluate the use of thyroglobulin values as a possible predictor of a dose of radioiodine therapy (RAI) in hyperthyroidism in patients GD, TA and TMG. Results The study included 105 patients (14.4 % males and 85.6% females). The average duration of the disease was 9 years. Graves’s disease is registered among 50.68%, toxic multinodular goiter among 30.83% and toxic adenoma among 18.49% of patients. Patients were divided into four groups, and they received four doses of radioiodine therapy: 10mCi, 15mCi, 20mCi and 25mCi. The values of thyroglubulin were measured before RAI, and in period of one, three and six months after the therapy. Conclusion It can be concluded that the higher average value of thyroglobulin before therapy suggests the need for administering a higher doses of RAI, so determination of thyroglobulin levels in serum, may serve as a good predictor to assist in monitoring the administered dose of RAI in patients with hyperthyroidism.

Frequency of Pathological Types of Hyperthyroidism in Thyroid Scan Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Ali Pooria ◽  
Afsoun Pourya ◽  
Alireza Gheini
Keyword(s):  
Multinodular Goiter ◽  
Clinical Information ◽  
Thyroid Stimulating Hormone ◽  
Graves Disease ◽  
Toxic Adenoma ◽  
Aged Patients ◽  
Cross Sectional ◽  
Radioiodine Uptake ◽  
Systemic Disorder ◽  
Toxic Multinodular Goiter

Background: Hyperthyroidism is a common systemic disorder where Graves’ disease is known as the leading cause of the disease. Thyroid stimulating hormone, T4 and T3 antibody assay are usually performed for the diagnosis of the pathology. However, with uncertainty in the results and in order to estimate the magnitude and the exact cause of the disease, radioactive iodine uptake (RAIU) test is recommended. The aim of this study is to evaluate underlying pathology in the patients presenting hyperthyroidism using RAIU test results. Methods: This is a cross-sectional retrospective study conducted on the patients with hyperthyroidism referred to Shahid Madani Hospital in Khorramabad. Data regarding the biochemical analysis and RAIU test was collected from the records and a questionnaire based on demographic and clinical information was completed for each patient. Results: Of 137 patients presenting hyperthyroidism, 62.04% were presented with Graves’ disease, 24.08% with toxic multinodular goiter and 13.86% with toxic adenoma. 24-hour RAIU test showed that the percent of radioiodine uptake was most in toxic adenoma 67.7%, Graves’ disease 53.5% and multinodular goiter 39%, respectively. From the age-based analysis, we found that Graves’ was most common in 20-30 years old individuals 34%, multinodular goiter in 50+ aged individuals 36.3% and toxic adenoma was most prevalent in 30-40 and 50+ aged patients, 26.3% each. In our population of interest, 81.8% toxic multinodular goiter patients were females. Conclusions: Our study presents the outcome of RAIU tests in hyperthyroidism based on the underlying pathologies. We also conclude, in light of other findings, Graves’ disease is the most common cause of hyperthyroidism in our population.

scholarly journals MON-LB59 Radiofrequency Ablation as a Primary Therapy for Benign Functioning Insulinoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ebtihal Y Alyusuf ◽  
Aishah Ali Ekhzaimy ◽  
Basil Alomair
Keyword(s):  
Radiofrequency Ablation ◽  
Treatment Option ◽  
Standard Of Care ◽  
Uncinate Process ◽  
Therapeutic Modality ◽  
Treatment Modalities ◽  
Surgical Removal ◽  
Primary Therapy ◽  
Alternative Treatment Option

Abstract Background Insulinomas are rare life-threatening pancreatic neuroendocrine tumors. Surgical removal continues to be the treatment of choice for such benign cases with a high cure rate. However, surgery is associated with a considerable risk of morbidity and mortality.Here we describe a case of benign solitary insulinoma successfully treated with RFA in a patient who strongly refused surgery. Case Description A 56-year- old non- diabetic, male is known to have hypertension and lymphoma diagnosed at age of 20 years, in remission. He presented with recurrent episodes of transient ischemic attack and stroke over the last three years. A change in his cognitive function, behavior, and memory was noticed. During his hospital stay for the second episode of stroke, he was found to have hypoglycemia which was asymptomatic. Insulinoma was confirmed based on the followings: low plasma glucose level of 2.04 mmol/l (4.0- 5.6), inappropriately elevated plasma f insulin and C-peptide 68.9 mU/l (3-13) and 4.08 ug/l (1.0-3.1); respectively. Sulfonylurea screening test was negative. MRI of the abdomen showed a 3.2x2.5 cm, well-circumscribed hypervascular lesion at the uncinate process of the pancreas, which is compatible with neuroendocrine tumor. Treatment modalities have been explained to the patient who was fully informed about the risk and benefit of each treatment option. However, he strongly refused surgery. Meanwhile, he was admitted with a third attack of stroke with concurrent hypoglycemia. In view of his refusal of the surgical treatment and due to his recent stroke and high-risk status for surgery, the option of radiofrequency ablation was decided. RFA of the pancreatic tumor using 40.75 GY fractions was carried out with a favorable outcome. The patient achieved biochemical normalization and remains euglycemic during his follow up. Reversal of his cognitive, behavioral, and memory changes was recognized. CT abdomen during a follow-up of 2 months after radiation showed a mild regression of the size of the tumor with no evidence of new lesions or distance metastasis. He remained under close follow up at the neuroendocrine clinic. Conclusion This case shows a treatment challenge which required the use of an alternative treatment option other than the standard of care in managing a case of benign insulinoma. Successful treatment was achieved in our case with the use of RFA rather than surgery. This report highlights the evolving evidence of nonsurgical RFA being a potential safe, feasible therapeutic modality option or even an alternative to surgery in selected cases of benign insulinoma. Because of the rarity of this tumor and low rate of therapeutic application of RFA in similar cases, the role of RFA had not been extensively studied. Large studies are needed to evaluate the long-term outcomes of RFA in this setting.

scholarly journals A case of papillary thyroid carcinoma in toxic adenoma: are hyperfunctioning nodules truly innocent all the times?

2017 ◽  
Vol 4 (3) ◽  
pp. 1093
Author(s):  
Banu Sarer Yurekli ◽  
Hatice Ozisik ◽  
Nilufer Ozdemir Kutbay ◽  
Ozer Makay ◽  
Gokhan Ozgen ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Thyroid Tissue ◽  
Follicular Neoplasm ◽  
Pathology Report ◽  
Papillary Thyroid ◽  
Toxic Adenoma ◽  
Thyroid Lobectomy

Thyroid nodule is seen commonly in clinical practice. Thyroid scintigraphy should be performed for the evaluation of thyroid nodules in case of suppressed TSH. We would like to present a case of toxic adenoma with the diagnosis of papillary thyroid carcinoma. Forty-four-year-old female patient had applied to the hospital with the diagnosis of thyroid nodule. Thyroid fine needle aspiration biopsy (FNAB) was performed for the evaluation of thyroid nodule measured as 47x12 mm. This nodule was in mixed solid form bearing cystic components. FNAB revealed that the thyroid nodule was benign. Our ultrasonographic evaluation was consistent with a thyroid nodule located at right lobe with a diameter of 43x18x28 mm. The patient underwent right thyroid lobectomy. Pathology report revealed macrofollicular variant of papillary thyroid carcinoma. The tumor was 3.5 cm in diameter with regular margin and 0.2 cm away from the surgical border. The tumor didn’t spread out of the thyroid capsule. Second thyroid surgery was performed due to remaining thyroid tissue. After that ablative radioactive iodine therapy was applied. Guidelines in Endocrine literature report that hyperfunctioning nodules are almost always benign. However, the risk of malignancy was reported as a weighted rate of 3.1%. As follicular lesions are seen in high percentage in hot nodules, surgery should be recommended in case of the cytological results of a follicular neoplasm of a hyperfunctioning nodule. So, hyperfunctioning thyroid nodules warrants careful evaluation and appropriate therapy. We wanted to draw attention of the clinicians for this rare issue.

Extended Retrosigmoid Approach for Resection of a Lateral Pontine Arteriovenous Malformation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Joshua S Catapano ◽  
Rohin Singh ◽  
Visish M Srinivasan ◽  
Michael T Lawton
Keyword(s):  
Arteriovenous Malformation ◽  
Effective Treatment ◽  
Surgical Resection ◽  
Treatment Option ◽  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Retrosigmoid Approach ◽  
Treatment Modalities ◽  
Effective Treatment Option ◽  
Patient Consent

Abstract Pontine arteriovenous malformations (AVMs) are uncommon lesions, with few reports in the literature. The best treatment option is debated, with options including surgical resection, endovascular embolization, and radiosurgery. Patient consent for the procedure was obtained. Herein, we report the successful resection of a ruptured lateral pontine AVM with an associated aneurysm in a woman in her early 70s. Surgical resection can be considered an effective treatment option for brainstem AVMs and should be considered alone or in conjunction with other treatment modalities. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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