Author(s)
Ezer Haim Benaim, BA
Michael J. Herr, PhD
Madhu Mamidala, PhD
M. Boyd Gillespie, MD MSc
Affiliation(s)
University of Tennessee Health Science Center
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to explain the indication, mechanism, effectiveness, and limitations of HIFU for benign solid thyroid nodules.
Objectives: High intensity focused ultrasound (HIFU) is a noninvasive treatment option for larger, benign thyroid nodules causing compressive symptoms or cosmetic concerns. The objective of this study is to determine the effectiveness of HIFU in the treatment of benign thyroid nodules.
Study Design: Literature search of PubMed, Scopus, Cochrane, and Ovid by two independent authors was used to evaluate studies reporting HIFU for single use treatment of benign, predominantly solid, thyroid nodules.
Methods: Study characteristics, patient demographics, nodule pre- and post-ablative size, and adverse effects outcomes were extracted. Primary outcomes were the volume reduction rate (VRR) and the success rate (percentage of patients with >50% VRR).
Results: Seven of 29 articles reviewed met inclusion criteria -- two prospective and five retrospective. Most exclusions were based on overlapping patient populations or incomplete data. In total, 235 nodules in 232 patients and 203 nodules in 203 patients were assessed at 1 and 2 year followup, respectively. Nodules assessed were in overwhelmingly female populations (0 to 22.6% male). Average baseline nodule volume ranged from 3.1 to 21.7 mL. Mean VRR (%) at one, three, six, twelve, and twenty-four months was 23.68, 46.03, 56.21, 60.30, and 52.17, respectively. The success rate at 6 months ranged from 6.4% to 81.8%. Pain was the most common adverse effect. Edema, unilateral vocal cord paresis, Horner's syndrome, and hoarseness were also reported.
Conclusions: HIFU has a broad range of effectiveness as a noninvasive alternative treatment. Further studies must be performed to optimize not only the therapy but also patient selection criteria to achieve higher success rates.