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Laser Surgery an Option for Benign Thyroid Nodules
By John Otrompke
CHICAGO, I.L. -- May 1, 2006 -- A new strategy for office-based treatment appears to be effective for common benign thyroid nodules, according to research presented here at the American Association of Clinical Endocrinologists (AACE) 15th annual meeting and clinical congress.
"There have traditionally been two approaches to the treatment of benign thyroid nodules," said Roberto Valcavi, MD, director, Thyroid Disease Center, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. "This is the seventh most common tumor in the female sex. Over fifty percent of women over 50 years old have some nodules in the thyroid."
In his presentation on April 28th, Dr. Valcavi said the first traditional strategy is medical treatment with thyroxine. "But this 30-year-old drug has recently been shown to be ineffective in a meta-analysis of 7 studies," he said. In addition, some menopausal patients may have a worsening of osteoporosis or heart problems when treated with thyroxine due to an excess of the hormone in the blood, he said.
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The second traditional approach has been lobectomy (or thyroidectomy in cases of bilateral nodule involvement). But this procedure can sometimes result in decreased calcium levels, or in vocal cord damage, he said.
In a prospective study of 119 women, Dr. Valcavi and colleagues evaluated the efficacy and safety of a new procedure, in which he placed under ultrasound guidance optic fibers 8 to 12 mm apart along the length of the benign thyroid nodule, and illuminated 1 to 4 fibers with a Nd:YAG laser. "The fibers were pulled back in order to achieve the greatest tissue exposure to laser illumination," the researchers explained in their poster.
"Using a slight sedative such as valium, the procedure took half an hour," he said, noting that open surgery with a general anesthetic usually takes at least an hour. Potential side effects of the minimally invasive procedure include nerve damage, but this occurs less often than with traditional surgery, he said.
"No laryngeal dysfunction or any major side effect was observed," the poster said, although 25.8% of the 93 initial patients had transient discomfort for less than an hour, while over 12% complained of tenderness for up to 6 days.
"Up to now we have not been able to take out the whole, such as the tissue close to the carotid artery, so this technique is not applied to malignancies," Dr. Valcavi noted.
[Presentation title: Percutaneous Laser Ablation (PLA) in Benign Thyroid Nodules. Poster 167]
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