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Eun Ju Ha 1, Jung Hwan Baek 1, Jeong Hyun Lee 1, Jin Young Sung 2, Jae Kyun Kim 3, Young Kee Shong 4 1 Department of Radiology and Research Institute of.

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Presentation on theme: "Eun Ju Ha 1, Jung Hwan Baek 1, Jeong Hyun Lee 1, Jin Young Sung 2, Jae Kyun Kim 3, Young Kee Shong 4 1 Department of Radiology and Research Institute of."— Presentation transcript:

1 Eun Ju Ha 1, Jung Hwan Baek 1, Jeong Hyun Lee 1, Jin Young Sung 2, Jae Kyun Kim 3, Young Kee Shong 4 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center 2 Department of Radiology, Thyroid Center, Daerim St. Marys Hospital 3 Department of Radiology, Chung-Ang University College of Medic ine 4 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous Lobectomy

2 Previous lobectomy patients Symptomatic benign thyroid nodule in the remaining thyroid gland What would be the best treatment option for this patient?

3 For patients with previous lobectomy Surgical treatment Risks of recurrent laryngeal nerve injury and hypoparathyroidism Permanent hypothyroidism Introduction Monzani et al Clin Endocrinol (Oxf) 46:9-15 Baek et al. AJR Am J Roentgenol 194: Papini et al Curr Opin Endocrinol Diabetes Obes 15: Valcavi et al.2010.Thyroid 20: Lefevre et al Langenbecks Arch Surg 392: Rafferty et al J Am Coll Surg 205: Non-surgical treatments (RF-, laser- and ethanol ablation) attractive treatment options that may preserve thyroid function

4 Regarding thyroid function, Transient hyperthyroidism in a few patients Permanent hypothyroidism in two patients: the reason was unclear Thyroid function seems to be rarely influenced by RF ablation but no studies in patients with previous lobectomy RF ablation Kim et al.2006.Thyroid 16: Jeong et al Eur Radiol 18: Baek et al Radiology 262:

5 To evaluate whether RF ablation for the treatment of benign thyroid nodules affects thyroid function in patients with previous lobectomy Purpose

6 Inclusion criteria patients of previous lobectomy due to benign thyroid nodules Inclusion criteria 11 patients with 14 thyroid nodules 7 patients Hypothyroidism before RFA 4 patients FU for less than 6-month Exclusion Materials & Methods (1)predominantly solid nodule (2)pressure symptoms or cosmetic problems (3)cytologic confirmation of benignancy at least twice (4)no malignant features detected using US (5)refusal of surgery

7 The Procedure of RF ablation By an experienced radiologist Using the Cool-Tip RF system, Internally cooled electrode Using the Moving shot technique Materials & Methods Baek et al Korean J Radiol. 12:

8 Pre-procedural evaluation Clinical concern: symptomatic (0-10) / cosmetic (1-4) scores US examination: the largest diameter, volume Laboratory test: TSH, fT4, T3, anti-TPO/Tg/TSHRc Ab Follow-up periods Clinical concerns, US examination: 1-, 6-month, and last F/U Laboratory test: 6-month, and last F/U Complications Materials & Methods

9 Statistical analysis SPSS for Windows (version14.0; SPSS, Chicago, IL) Compare the variables at the time of enrollment and the last F/U : Wilcoxons signed rank test Materials & Methods

10 Follow-up duration : 43.7 ± 30.7 months Interval (surgery- RF ablation): ± months Efficacy CharacteristicEnrollmentLast follow-upP value Volume (mL)9.7±36.3 ( )2.8±12.4 ( )0.001 Symptom score4.6 ± 2.1 (2-9)1.4 ±0.7 (0-5)0.003 Cosmetic score3.5 ±0.0 (3-4)1.5±0.7 (1-3)0.003 VRR at last follow-up : 87.2% Results

11 Thyroid Function Thyroid Antibodies None of the patients showed newly developed thyroid antibodies during the F/U CharacteristicEnrollmentLast follow-upP value Thyrotropin (mU/mL)1.7±1.1 ( )2.0 ± 1.2 ( )0.306 Free thyroxine (ng/dL)1.4± 0.1( )1.4±0.2 ( )0.789 Triiodothyronine (ng/dL)113.3±6.4 ( )113.3±21.2 ( )0.878 Results Each value is the mean ± SD, with the range in parenthesis

12 Results (-/-/-) 92-month F/U

13 Complications : no major complications including voice change None of the patients required additional surgery Results

14 Case 2 RF ablations Improvement of symptomatic and cosmetic problems

15 Thyroid function was well preserved in all patients The efficacy is usually confined to targeted nodules => damage to surrounding normal thyroid gland can be minimized Discussion

16 Comparison with LA and EA Baek et al. Valcavi et al. Monzani et al. Livraghi et al. Published journalRadiologyWJSThyroidClin EndocrinolRadiology Published year Ablation methodsRF LaserEA N. of patients Mean diameter 3.8 ± 1.4 cm3.2 ± 1.4cm cm (range)> 3cm Hypothyroidism11211 Thyroid Abs TPO AbTg AbTPO Ab/Tg Ab TPO Ab Note.NFTNAFTNNFTNAFTN Discussion Abbreviations: Tg: Thyroglobulin, TPO: Thyroid peroxidase, Ab: antibody NFTN: nonfunctioning thyroid nodule, AFTN: autonomously functioning thyroid nodule

17 The cause of hypothyroidism… Discussion Progression of autoimmune thyroiditis Treatment of autonomously functioning thyroid nodule (AFTN) It may be necessary to warn the patients with thyroid antibodies and the patients with AFTNs about the possibility of hypothyroidism prior to the treatment

18 In patients with previous lobectomy, RF ablation has advantages in terms of maintaining thyroid function should be considered as a first-line treatment Conclusion

19 THANK YOU FOR YOUR ATTENTION


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