Combination of Ultrasound-Guided Percutaneous Microwave Ablation and Radioiodine Therapy in Benign Thyroid Disease: A 3-Month Follow-Up Study

 

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Abstract

Purpose: Pilot studies of combined therapies treating benign nodular goiters reported promising results. The aim of this study was to investigate the effectiveness of combined microwave ablation (MWA) and radioiodine therapy (RIT) with a special focus on thyroid function at the 3-month follow-up.

Materials and Methods: 15 patients (median age: 55 years) with a large goiter and benign thyroid nodules or Graves’ disease were treated with the combined therapy. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobuline (Tg) and, additionally, antibody levels against thyroglobulin (TgAb), thyrotropin receptors (TRAb) and thyroid peroxidase (TPOAb) were measured at enrollment, post MWA and at the 3-month follow-up (3MFU). Furthermore, the goiter volume, I-131 dose and hospitalization time were analyzed to evaluate effectiveness. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928 MHz.

Results: TSH, T4, T3 and Tg did not change at 3MFU, except for in two patients in whom the initial TSH levels improved to normal thyroid functioning levels at follow-up. One of the patients developed a high TRAb-level that receded back into the normal range. At 3MFU, the combined therapy showed a mean thyroid volume reduction of 26.4 ml ± 7.9 ml (30.5 % ± 4.6 % (p < 0.05)). By utilizing the combined therapy, administered activity could be reduced by 26.6 % ± 4.8 % (p < 0.05) and hospitalization time by 30.9 % ± 19.9 % (p < 0.05).

Conclusion: The data confirmed the effectiveness of the combination of MWA with RIT. The combined therapy is an innovative and conservative approach and could become a safe alternative to surgery for the treatment of very large benign nodular goiters. Due to the short follow-up and the limited number of patients, further studies will be necessary.

Key Points:

• The combined therapy shows a significant volume reduction in benign nodular goiters

• Initial MWA improves the RIT results by reducing the required therapy activity

• Thyroid function is preserved after combined therapy

Citation Format:

• Korkusuz H, Happel C, Koch DA. et al. Combination of Ultrasound-Guided Percutaneous Microwave Ablation and Radioiodine Therapy in Benign Thyroid Disease: A 3-Month Follow-Up Study. Fortschr Röntgenstr 2016; 188: 60 – 68

Zusammenfassung

Ziel: Erste Studien zu verschiedenen Kombinationstherapien zur Behandlung benigner nodulärer Strumen überzeugten mit vielversprechenden Ergebnissen. Ziel der Studie war die Effektivität der kombinierten Mikrowellenablation (MWA) und Radiojodtherapie (RIT) zu prüfen, wobei die Schilddrüsenfunktion nach 3 Monaten im Fokus stand.

Material und Methoden: Fünfzehn Patienten (medianes Alter 55 Jahre) mit großen Strumen und Morbus Basedow oder benignen Schilddrüsenknoten erhielten die Kombinationstherapie. Im Serum wurden Triiodthyronin (T3), Thyroxin (T4), Thyreotropin (TSH), Thyreoglobulin (Tg) und Antikörper gegen Thyreoglobulin- (TgAK), Thyreotropin-Rezeptoren (TRAK) und Thyreoperoxidase (TPO-AK) bei der Voruntersuchung, post-MWA und bei der 3-monatigen Kontrolle (3MKU) untersucht. Um die Effektivität zu ermitteln, wurden zusätzlich Schilddrüsenvolumen, benötigte I-131-Therapieaktivität und Krankenhausliegedauer analysiert. Für die unter Lokalanästhesie durchgeführte MWA wurde ein System im Wellenlängenbereich von 902 bis 928 MHz eingesetzt.

Ergebnisse: TSH, T4, T3 und Tg veränderten sich bei der 3MKU gegenüber den Initialwerten nicht; die Patienten blieben euthyreot, außer zwei Patienten, wo eine Verbesserung der initialen TSH-Werte in den Normbereich beobachtet werden konnte. Ein Patient entwickelte einen hohen TRAK-Wert, der sich jedoch wieder normalisierte. Die 3MKU ergab eine mittlere Volumenreduktion der SD um 26,4 ml ± 7,9 ml (30,5 % ± 4,6 % (p < 0,05)). Die benötigte Therapieaktivität konnte um 26,6 % ± 4,8 % (p < 0,05) und die Krankenhausliegedauer um 30,9 % ± 19,9 % (p < 0,05) gesenkt werden.

Schlussfolgerung: Die erhobenen Daten bestätigen die Effektivität der Kombination von MWA mit RIT. Die Kombinationstherapie ist ein innovativer und effektiver Ansatz und könnte in Zukunft als eine sichere Alternative zur operativen Entfernung großer benigner nodulärer Strumen gesehen werden. Aufgrund des kurzen Follow-ups und der geringen Patientenzahl müssen weitere Studien die Ergebnisse bestätigen.

Kernaussagen:

• die Kombinationstherapie weist eine signifikante Volumenreduktion bei großen benignen nodulären Strumen auf

• die initiale MWA ermöglicht durch eine Reduktion der benötigten Therapieaktivität eine effizientere RIT

• die Schilddrüsenfunktion bleibt bei der kombinierten Therapie erhalten

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