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Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules

2007; Oxford University Press; Volume: 157; Issue: 1 Linguagem: Inglês

10.1530/eje-07-0094

1479-683X

Helle Døssing, Finn Noe Bennedbæk, Steen Joop Bonnema, Peter Grupe, László Hegedűs,

Head and Neck Anomalies

Objective : To compare the efficacy of interstitial laser photocoagulation (ILP) with radioiodine in hot thyroid nodules. Design : Thirty consecutive outpatients with subclinical or mild hyperthyroidism and a scintigraphically solitary hot nodule with extraglandular suppression were randomized to either one ILP session or one radioiodine ( 131 I) dose. Methods : ILP was performed under continuous ultrasound-guidance and with an output power of 2.5–3.5 W. 131 I was given as a single dose based on thyroid volume and a 24-h thyroid 131 I uptake. Thyroid function and nodule volume were evaluated at inclusion and at 1, 3 and 6 months after treatment. Results : Normalization of serum TSH was achieved in 7 out of 14 patients in the ILP group and in all 15 patients in the 131 I group ( P =0.0025). In the ILP group, mean thyroid nodule volume reduction was 44±5% ( s.e.m .; P <0.001), and in the 131 I group 47±8% ( P <0.001), within 6 months, without between-group difference ( P =0.73). The mean reduction of total thyroid volume was 7±5% in the ILP group ( P =0.20) and 26±8% ( P =0.006) in the 131 I group ( P =0.06 between-group). Two patients in the 131 I group developed hypothyroidism but no major side effects were seen. Conclusions : This first randomized study, comparing ILP with standard therapy, demonstrates that ILP and 131 I therapy approximately halves thyroid nodule volume within 6 months; but in contrast to 131 I, extranodular thyroid volume is unaffected by ILP and no patient developed hypothyroidism. Using the present design, ILP seems inferior to 131 I therapy in normalization of serum TSH. The potential value of ILP as a non-surgical alternative to 131 I needs further investigation.