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Mauri, Giovanni; Papini, Enrico; Bernardi, Stella; Barbaro, Daniele; Cesareo, Roberto; De Feo, Pierpaolo; Deandrea, Maurilio; Fugazzola, Laura; Gambelunghe, Giovanni; Greco, Gabriele; Messina, Carmelo; Monti, Salvatore; Mormile, Alberto; Negro, Roberto; Offi, Chiara; Palermo, Andrea; Persani, Luca; Presciuttini, Federica; Solbiati, Luigi Alessandro; Spiezia, Stefano; Stacul, Fulvio; Viganò, Marco; Sconfienza, Luca Maria
European radiology, 03/2022, Letnik: 32, Številka: 3Journal Article
Objectives To report the results of a multicenter retrospective evaluation of the clinical outcomes of thermal ablation (TA) in a large series of autonomously functioning thyroid nodules (AFTN) with a follow-up protracted up to 3 years. Methods Patients treated with single TA for an AFTN in Italy were included. Changes in nodule volume, TSH values, and ongoing anti-thyroid therapy were assessed at the 2-, 6-, 12-, 24-, and 36-month follow-up controls. Complications and need of any additional therapy after TA were also registered. Results A total of 361 patients (244 females, 117 males, median age 58 years, IQR 46–70 years) were included. Nodule volume was significantly reduced at all time points ( p < 0.001) (median volume reduction 58% at 6-month and 60% at 12-month). Serum TSH values increased significantly at all time points. After TA, anti-thyroid therapy was withdrawn in 32.5% of patients at 2 months, in 38.9% at 6 months, and in 41.3% at 12 months. A significant difference in the rate of patients who withdrawn medical therapy at 12 months was registered between small (< 10 mL) (74%), medium (49%), or large (> 30 mL) nodules (19%). A single major complication occurred (0.25%). Additional treatments were needed in 34/361 (9.4%) of cases including 4 (1.1%) surgical treatment. Conclusions Image-guided thermal ablation offers a further safe and effective therapeutic option in patients with AFTN. Clinical outcomes are significantly more favorable in small than in large size AFTN. Key Points • Thermal ablations (TA) can be safely and effectively used in patients with autonomously functioning thyroid nodules (AFTN). • TA results in a clinically significant nodule volume reduction that is paralleled by TSH level normalization and anti-thyroid drug therapy discontinuation (after TA anti-thyroid therapy was withdrawn in 41.3% at 12 months). • Clinical outcomes after TA are more favorable in small nodules, and when a large amount of thyroid nodule tissue is ablated.
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