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IL NODULO TIROIDEO IPERFUNZIONANTE
MIT: EVIDENZE DELLA LETTERATURA
ROBERTO CESAREO
LATINA
Progressively growing benign, thyroid lesions that reach to a volume over 12 ml seem to be especially suited for minimally invasive procedures.
Less appropriate indications are large nodular goitres, multinodular thyroid disease or deeply positioned lesions.
European Journal of Endocrinology (2014)
VOLUME 20X18X21 = 4,1 ml
VOLUME 2.8X2.8X3.2 = 13 ml
VOLUME THYROID NODULE
NODULO SMALL
NODULO MIDDLE
NODULO LARGE
VOLUME 46X34X46 = 37 ml
Nodulo small <12 ml
Nodulo Middle 12 e 30ml
Nodulo Large >30 ml
VOLUMETRIC CLASSIFICATION
For patients with toxic adenoma, the risk of
treatment failure is < 1% after surgical resection
(ipsilateral thyroid lobectomy or isthmusectomy)
The prevalence of hypothyroidism is 2.3% following
lobectomy for toxic adenoma
Postradioiodine hypothyroidism may develop in up to 60% after
20 years
However, radioiodine is not suited for large nodules that
require high doses of radioiodine and may be unresponsive to
treatment
ENDOCRINE PRACTICE 2010
Int J Endocrinol Metab. 2014
Patients with end-stage renal failure cannot excrete radioiodine normally
Breast feeding
Pregnancy
Drugs with a high iodine content (amiodarone, saturated solution of potassium iodide or radiocontrast media)
Claustrophobic patients
RADIOIODINE TREATMENT
Exclusion Criteria
THYROID 2017
Long-term ATD treatment is effective and safe, especially in adults,
indicating that it should be considered as an alternative treatment for
Graves’ disease.
LASER THERMAL ABLATION
RADIOFREQUENCY
MOVING SHOT AND HOOK UMBRELLA
ENDOCRINE PRACTICE Vol 22 No. 5 May 2016
ENDOCRINE PRACTICE Vol 22 No. 5 May 2016
Endocr Pract 2007
The total number of PLA sessions
ranged from 1 to 5 (median, 3)
Combined treatment determined faster volume reduction and relief of symptoms, and faster control of hyperthyroidism.
In group (LAT131I), however, normalization of TSH occurred in nine of 15 patients (60%) already 1 month after LAT; in particular, in three of these patients radioiodine was not necessary
J Clin Endocrinol Metab 2014
Int J Hypert 2017
Endocrine 2015
The patients that went into remission had their
nodules reduced on average by 81 %, as compared
to those that improved, which were reduced on average
by 68% after 12 months from the procedure
The mean number
of treatment session was
1.8 ± 0.9
(range, 1 - 6 sessions))
Thyroid 2015
Int J Hypert 2018
Int J Hyper2018
Scintigrafia_t0 scintigrafia_t24
hot coldDrop-
out hot cold
VOLUME NODULO
<1215 0 1 2 12
>1214 0 3 9 2
Int J Hypert 2018
Clin End 2019
UNDER REVISION 2019
Under Rev 2019
Under Rev 2019
Under Rev 2019
Under Rev 2019
Korean J Radiol 2018
Int J Hypert 2019
TAKE HOME MESSAGES
Strong evidences
⚫ Toxic or pre-toxic thyroid nodule < 5/10 ml
⚫ The patient refuses surgery or cannot do
surgery or RM treatment
⚫ THY-2 at citological examination
⚫ Nodule > 20 ml: what should we do?
⚫ Is it cost-effective to performe more
treatments?
⚫ More of these nodules are THY 3a:
What shall we do in this context?
TAKE HOME MESSAGES
Low evidences
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