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Eun Ju Ha 1 , Jung Hwan Baek 1 , Jeong Hyun Lee 1 , Jin Young Sung 2 ,

RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous Lobectomy. Eun Ju Ha 1 , Jung Hwan Baek 1 , Jeong Hyun Lee 1 , Jin Young Sung 2 , Jae Kyun Kim 3 , Young Kee Shong 4

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Eun Ju Ha 1 , Jung Hwan Baek 1 , Jeong Hyun Lee 1 , Jin Young Sung 2 ,

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  1. RF Ablation of Benign Thyroid Nodules Does Not Affect Thyroid Function in Patients with Previous Lobectomy Eun Ju Ha1, Jung Hwan Baek1, Jeong Hyun Lee1, Jin Young Sung2, Jae Kyun Kim3 ,Young Kee Shong4 1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center 2Department of Radiology, Thyroid Center, Daerim St. Mary’s Hospital 3Department of Radiology, Chung-Ang University College of Medicine 4Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center

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

  3. Introduction • For patients with previous lobectomy • Surgical treatment • Risks of recurrent laryngeal nerve injury and hypoparathyroidism • Permanent hypothyroidism Lefevre et al. 2007. Langenbecks Arch Surg 392:685-691 Rafferty et al. 2007. J Am Coll Surg 205:602-607 • Non-surgical treatments(RF-, laser- and ethanol ablation) attractive treatment options that may preserve thyroid function Monzani et al. 1997. Clin Endocrinol (Oxf) 46:9-15 Baek et al. AJR Am J Roentgenol 194:1137-1142 Papini et al. 2008. Curr Opin Endocrinol Diabetes Obes 15:434-439 Valcavi et al.2010.Thyroid 20:1253-1261

  4. RF ablation • Regarding thyroid function, • Transient hyperthyroidism in a few patients • Permanent hypothyroidismin two patients: the reason was unclear Thyroid function seems to be rarely influenced by RF ablation but no studies in patients with previous lobectomy Kim et al.2006.Thyroid 16:361-367 Jeong et al. 2008. Eur Radiol 18:1244-1250 Baek et al. 2012. Radiology 262:335-342

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

  6. 7 patients Hypothyroidism before RFA • predominantly solid nodule • pressure symptoms or cosmetic problems • cytologic confirmation of benignancy at least twice • no malignant features detected using US • refusal of surgery Materials & Methods Exclusion 4 patients FU for less than 6-month • Inclusion criteria 2002.6-2009.12 22 patients of previous lobectomy due to benign thyroid nodules Inclusion criteria 11 patients with 14 thyroid nodules

  7. Materials & Methods • The Procedure of RF ablation • By an experienced radiologist • Using the Cool-Tip RF system, Internally cooled electrode • Using the Moving shot technique Baek et al. 2011 Korean J Radiol. 12:525-540 • < Illustration for Moving Shot Technique>

  8. Materials & Methods • 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

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

  10. Results • Follow-up duration : 43.7 ± 30.7 months • Interval (surgery- RF ablation):122.9 ± 151.3 months • Efficacy • VRR atlast follow-up :87.2%

  11. Results • Thyroid Function Each value is the mean ± SD, with the range in parenthesis • Thyroid Antibodies • None of the patients showed newly developed thyroid antibodies during the F/U

  12. Results 92-month F/U

  13. Results • Complications :no major complicationsincluding voice change • None of the patients required additional surgery

  14. Case Improvement of symptomatic and cosmetic problems 2 RF ablations

  15. Discussion ① • 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

  16. Discussion ② Comparison with LA and EA Abbreviations: Tg: Thyroglobulin, TPO: Thyroid peroxidase, Ab: antibody NFTN: nonfunctioning thyroid nodule, AFTN: autonomously functioning thyroid nodule

  17. Discussion ② • The cause of hypothyroidism… 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 AFTNsabout the possibility of • hypothyroidism prior to the treatment

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

  19. Thank you For Your ATtention

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