scholarly journals Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Giovanni Mauri ◽  
Franco Orsi ◽  
Serena Carriero ◽  
Paolo Della Vigna ◽  
Elvio De Fiori ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Thyroid Function ◽  
Active Surveillance ◽  
Thermal Ablation ◽  
Thyroid Function Tests ◽  
Papillary Thyroid ◽  
Technical Success ◽  
Image Guided ◽  
Thyroid Microcarcinoma

PurposeTo report the results of our preliminary experience in treating patients with papillary thyroid microcarcinoma (PTMC) with image-guided thermal ablation, in particular estimating the feasibility, safety and short-term efficacyMaterials and MethodsFrom 2018 patients with cytologically proven PTMC < 10 mm were discussed in a multidisciplinary team and evaluated for feasibility of image-guided thermal ablation. In case of technical feasibility, the three possible alternatives (i.e., image-guided thermal ablation, surgery, and active surveillance) were discussed with patients. Patients who agreed to be treated with image guided thermal ablation underwent radiofrequency (RFA) or laser ablation under local anesthesia and conscious sedation. Treatment feasibility, technical success, technique efficacy, change in thyroid function tests, side effects, minor and major complications, patients satisfaction and pain/discomfort perception during and after treatment, and disease recurrence during follow-up were recorded.ResultsA total of 13 patients were evaluated, and 11/13 (84.6%) patients (9 female, 2 male, mean age 49.3 ± 8.7 years) resulted suitable for image-guided thermal ablation. All 11 patients agreed to be treated with image-guided thermal ablation. In addition, 3/11 (27.3%) were treated with laser ablation and 8/11 (72.7%) with RFA. All procedures were completed as preoperatively planned (technical success 100%). Technique efficacy was achieved in all 11/11 (100%) cases. Ablated volume significantly reduced from 0.87 ± 0.67 ml at first follow-up to 0.17 ± 0.36 at last follow-up (p = 0.003). No change in thyroid function tests occurred. No minor or major complications occurred. All patients graded 10 the satisfaction for the treatment, and mean pain after the procedure was reported as 1.4 ± 1.7, and mean pain after the procedure as 1.2 ± 1.1 At a median follow-up of 10.2 months (range 1.5–12 months), no local recurrence or distant metastases were found.ConclusionsImage guided thermal ablations appear to be feasible and safe in the treatment of PTMC. These techniques hold the potential to offer patients a minimally invasive curative alternative to surgical resection or active surveillance. These techniques appear to be largely preferred by patients.

scholarly journals Active Surveillance of Papillary Thyroid Microcarcinoma: Where Do We Stand?

2019 ◽  
Vol 8 (6) ◽  
pp. 298-306 ◽  
Author(s):  
Min Ji Jeon ◽  
Won Gu Kim ◽  
Ki-Wook Chung ◽  
Jung Hwan Baek ◽  
Won Bae Kim ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Volume Measurement ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Major Drawback ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

The recent sharp increase in thyroid cancer incidence is mainly due to increased detection of small papillary thyroid microcarcinoma (PTMC). Due to the indolent nature of the disease, active surveillance (AS) of low-risk PTMCs is suggested as an alternative to immediate surgery to reduce morbidity from surgery. For appropriately selected PTMC patients, AS can be a good management option and surgical intervention can be safely delayed until progression occurs. Many considerations must be taken into account at the time of initiation of AS, including radiological tumor characteristics and clinical characteristics of the patient. A specialized medical team should be assembled to monitor patients during AS with an appropriate follow-up protocol. The fact that some patients require surgery for disease progression after long-term follow-up is a major drawback of the current AS protocol. Evaluation of tumor kinetics by three-dimensional tumor volume measurement during the initial 2–3 years of AS may be helpful for discrimination of PTMCs that need early surgical intervention. In this review, we will discuss the clinical outcomes of surgical intervention and AS, considerations during AS, and unresolved questions about AS.

Effect of Initial Treatment Choice on 2-year Quality of Life in Patients with Low-risk Papillary Thyroid Microcarcinoma

2020 ◽  
Author(s):  
Jae Hoon Moon ◽  
Chang Hwan Ryu ◽  
Sun Wook Cho ◽  
June Young Choi ◽  
Eun-Jae Chung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Progression ◽  
Active Surveillance ◽  
Initial Treatment ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

Abstract Context The long-term quality of life (QoL) in patients with low-risk papillary thyroid microcarcinoma (PTMC) underwent active surveillance (AS) and immediate surgery is unclear. Objective The aim of this study was to investigate the effect of initial treatment choice on 2-year QoL in patients with low-risk PTMC Design, Setting, and Participants We analyzed 2652 QoL surveys from 1055 subjects enrolled in ongoing multicenter prospective cohort study on active surveillance of PTMC, in which the median follow-up duration was 24.4 months. Major Outcome Measure We evaluated QoL of patients with low-risk PTMC according to their treatment modality using generalized estimating equation. Results Six hundred and seventy-four subjects (male = 161; mean age = 48.8 ± 11.9 years) with low-risk PTMC chose AS while 381 subjects (male = 75; mean age = 45.7 ± 10.4 years) chose immediate surgery, including lobectomy/isthmusectomy (L/I) and total thyroidectomy (TT). Among the 817 subjects who completed baseline QoL surveys, 2-year QoL was good in order of AS (n = 500), L/I (n = 238), and TT (n = 79) groups after adjustment for age, sex, baseline tumor size, and baseline QoL scores. Among the 101 subjects who changed their treatment from AS to surgery during the follow-up period, 35 subjects who changed treatment due to disease progression had better QoL than 66 subjects who had no disease progression. Conclusions This study identified QoL as a major issue in choosing an initial treatment of low-risk PTMC and highlighted the possibility of using AS as the primary treatment.

scholarly journals Therapeutic Effects of Ultrasound-Guided Percutaneous Laser Ablation for Primary Thyroid Microcarcinoma

2021 ◽  
Author(s):  
Feng Zhou ◽  
Zepeng Yu ◽  
Xingwei Sun ◽  
Qin Wu ◽  
Kun Zheng ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Postoperative Complications ◽  
Malignant Tumors ◽  
Therapeutic Effects ◽  
Efficacy And Safety ◽  
Papillary Thyroid ◽  
Ultrasound Guided ◽  
Thyroid Microcarcinoma ◽  
Percutaneous Laser Ablation

Abstract Background: Ultrasound-guided percutaneous laser ablation, as a minimally invasive ablation method, has been widely used in the treatment of benign and malignant tumors. The objective of the current study is to determine the efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for unifocal papillary thyroid micro carcinomas (PTMC).Methods: A total of 18 patients were included in this study. Patients with a single PTMC were treated via the PLA method, and postoperative complications, tumor size and recurrence rate were followed up and recorded.Results: Data suggested that three patients underwent a secondary ablation, and the remaining 15 patients underwent a single ablation without serious complications. No recurrence or metastasis was found among the follow-up patients, and the tumor sizes decreased significantly from 12 months following PLA treatment.Conclusions: Ultrasound-guided PLA is a new therapeutic means that can be used as an alternative to PTMC treatment.

scholarly journals OR28-06 Assessment of Long Term Quality of Life According to Treatment Options in Low Risk Papillary Thyroid Microcarcinoma Patients - Active Surveillance or Immediate Surgery, (A Follow up Interim Analysis of Maestro)

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Soo Myoung Shin ◽  
Sung Hye Kong ◽  
Junsun Ryu ◽  
Min Joo Kim ◽  
Sun Wook Cho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Active Surveillance ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Long Term Follow Up ◽  
Immediate Surgery

Abstract Background: The Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) started in June 2016. As a follow-up study of comparing the quality of life (QoL) of the active surveillance (AS) and immediate surgery (OP) groups at 8 months (9.3±4.8 and 7.1±4.2 months, respectively), here we aimed to compare the QoL between the AS and OP groups after 18 months (22.8±4.0 and 22.3±4.3 months, respectively) of follow-up. Methods: QoL of 108 participants who chose AS, 101 who underwent OP, twelve who changed from AS to OP was evaluated using a thyroid-specific QoL questionnaire at diagnosis and during follow-up (median 23 months). Results: The mean ages of the participants in the AS and OP groups were 47.7±11.0 and 45.1±10.0 years (p=0.075), respectively. At baseline, better physical (8.2±1.4 vs. 7.6±1.8, p=0.032), psychological (7.4±1.2 vs. 6.7±1.6, p=0.010), and total health (7.4±1.0 vs. 6.7±1.3, p=0.005) were observed in the AS group than in the OP group. After a mean follow up of 22.7±4.2 months, better physical (8.1±1.5 vs. 7.4±1.7, p=0.008), psychological (7.7±1.3 vs. 7.0±1.5, p=0.002), and total health (7.5±1.2 vs. 6.8±1.3, p=0.001) were observed in the AS group than in the OP group, whereas spiritual health was comparable between the two groups: compared with the AS group, the OP group experienced more alterations in appetite, sleep, menstrual cycle, voice, motor skill, weight, appearance, cold or heat tolerance, and body swelling. Furthermore, better QOL scores were observed in the AS group in self-concept, personal relationships, sexual life, work motivation, productivity and quality of work, feeling of isolation, driving, doing household chores, preparing meals and doing leisure activities after long term follow up. Conclusion: Patients who underwent AS had better QOL even after long term follow up. Low risk papillary thyroid microcarcinomas do not influence survival, however surgery related deterioration of QOL lasted long and did not improve even in late post-operative stages when patients were fully recovered from surgery. Keywords: Quality of life; papillary thyroid microcarcinoma; active surveillance; immediate surgery

Image-Guided Thermal Ablation in De Novo Renal Tumor Arising in Kidney Allograft: 3-Year Follow-Up. A Case Report

2021 ◽  
Author(s):  
Flavia de Gennaro ◽  
Roberto Iezzi ◽  
Gionata Spagnoletti ◽  
Maria Paola Salerno ◽  
Jacopo Romagnoli ◽  
...  
Keyword(s):  
Case Report ◽  
Thermal Ablation ◽  
De Novo ◽  
Renal Tumor ◽  
Kidney Allograft ◽  
Image Guided

scholarly journals Case Report: De Quervain’s Thyroiditis as a Long-Term Sequelae Complication to SARS-CoV-2 Infection

2021 ◽  
pp. 64-70
Author(s):  
Mark Kong ◽  
Sarah La Porte
Keyword(s):  
Case Report ◽  
Thyroid Function ◽  
Elevated Serum ◽  
Subacute Thyroiditis ◽  
Thyroid Function Tests ◽  
Thyroid Function Testing ◽  
Neck Lump ◽  
Function Testing

A 44-year-old man presented with an enlarged painful lower anterior neck lump with elevated serum concentrations of free thyroxine (T4) and tri-iodothyronine (T3), alongside the presence of antithyroid peroxidase antibodies. Prior to presentation, the patient was demonstrating recovery from a SARS-CoV-2 infection that required sedation, intubation, and invasive ventilation in the intensive care unit (ICU) for 11 days. Ultrasound examination of the thyroid demonstrated features of De Quervain’s (subacute) thyroiditis. This corresponded to the clinical picture, and continuous thyroid function tests were arranged. Emerging evidence throughout the SARS-CoV-2 pandemic describes the long-term sequelae of the infection, including developing atypical effects on the thyroid gland. This case report emphasises the association of painful subacute thyroiditis with post-viral infection and its manifestation during recovery from severe SARS-CoV-2, suggesting that follow-up thyroid function testing should be considered in patients discharged from the ICU who develop neck discomfort.

THYROID FUNCTION TESTS: A REVIEW

2021 ◽  
pp. 73-76
Author(s):  
Vasudev Sankhla ◽  
Aman Deep
Keyword(s):  
Thyroid Function ◽  
Thyroid Dysfunction ◽  
Radioactive Iodine ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Tsh Secretion ◽  
Line Test ◽  
Radioactive Iodine Uptake

Thyroid function tests are one of the most common endocrine panels in general practice because a good understanding of when to order them, indications for treatment are important for the optimal treatment of thyroid dysfunction. Thyroid-stimulating hormone (TSH) should be the rst test to be performed on any patient with suspected thyroid dysfunction and in follow-up of individuals on treatment. It is useful as a rst-line test because even small changes in thyroid function are sufcient to cause a signicant increase in TSH secretion. Thyroxine levels may be assessed in a patient with hyperthyroidism, to determine the severity of hyperthyroxinemia. Antithyroid peroxidase measurements should be considered while evaluating patients with subclinical hypothyroidism and can facilitate the identication of autoimmune thyroiditis during the evaluation of nodular thyroid disease. The measurement of TSH receptor antibody must be considered when conrmation of Graves’ disease is needed and radioactive iodine uptake cannot be done.

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