Laser ablation of large benign thyroid nodules

OBJECTIVE: To evaluate the efficacy and safety of several courses of low-energy laser thermal ablation (LTA) for large thyroid nodules. MATERIAL AND METHODS: A prospective study is devoted to results of LTA for large thyroid nodules. The study included 19 patients with nodular goiter who underwent laser ablation therapy. An output radiation power not exceeding 3 W was used, and amount of energy delivered to the nodule was increased by increasing the number of sessions without raising the radiation power associated with a risk of complications. Five procedures were performed per a course at weekly intervals with mandatory evaluation of effectiveness, tolerability, and complications after each session. If necessary, treatment was repeated after three months in patients without contraindications. In total, there were 216 ablation procedures for large thyroid nodules. RESULTS: The above-described LTA regimen demonstrated good tolerance. Peak pain was observed on the next day after procedure (VAS score 1.31) and improved over time. Major complication rate was 0.46%. Consistent mild enlargement of nodules followed treatment due to reactive edema. After 3 months, this enlargement regressed. After one course of treatment, technical success of ablation was observed in 45% of cases, after two courses - in 94%, after three courses - in 100% of cases. Symptoms of compression completely regressed in 60% of cases after three courses, while normalization of hormonal deviations was achieved in 50% of cases. CONCLUSION: One course of low-energy LTA is insufficient for reducing large thyroid nodules. Three courses of LTA ensure technical success of ablation in 100% of cases with minimal serious complications. However, complete elimination of symptoms and hormonal abnormalities does not occur universally and necessitates further treatment.