SAT493 Laser Ablation For Benign Thyroid Nodules: A Way To Treat And Still Preserve The Thyroid

Abstract

Abstract Disclosure: N. Kalara: None. D.L. Bignoli: None. C.M. Acosta: None. A. Manzano: None. Introduction: Thyroid nodules in adults have a prevalence of 3-7% based on palpation and 20-76% based on ultrasound examination. The majority of which are benign but some increase in size causing compressive symptoms or cosmetic concerns, thus, needing treatment. Laser ablation (LA) is a safe, non-surgical approach for the management of benign thyroid nodules now approved in the US. Nodule reduction is achieved through laser induced cytoreduction and tissue coagulation. Two benign FNA biopsies 3-6 months apart and a nodule size of more than 2.5 cm are some of the inclusion criteria for LA. We present a case of a benign thyroid nodule causing compressive symptoms where LA was done since the patient declined surgery. Case description: 76-year-old female with a history of type 2 diabetes mellitus, hypertension, and multinodular goiter for many years presented with concerns of neck fullness and discomfort for the past 6 months. Thyroid ultrasound confirmed a large dominant right complex nodule of 2.8 x 1.13 x 3 cm with a volume of 5 ml. Thyroid function test showed Thyroid stimulating hormone (TSH) 1.2 mIU/mL (0.40-4.50) and free T4 1.24 ng/dl (0.9-1.7). Two FNA biopsies done 3 months apart in the past were Bethesda II. Given the compressive symptoms due to a multinodular gland thyroidectomy was discussed as a treatment option with the patient which she declined. Hence, LA was discussed as an option for the largest nodule. The procedure was performed without complications. The nodule received 1450 Joules at 6 watts using one Elesta laser fiber. At the end of 2 months post-LA, thyroid ultrasound showed a significant reduction of the nodule with a current size of 1.5 x 1 x 1.6 cm and 1.4ml volume. She continued to be clinically and biochemically euthyroid with a total volume reduction close to 70% and complete resolution in compressive symptoms. Conclusion: Percutaneous laser ablation is a non-surgical, minimally invasive procedure to treat benign thyroid nodules that is now accessible in the US with promising results and a good safety profile. It is covered by insurance in various states. In our case the patient refused surgical intervention, thus, laser ablation was done that resulted in the resolution of her compressive symptoms without any complications. More awareness regarding the laser ablation procedure and its availability for patients is needed, especially in cases where preservation of the thyroid gland is desired. Reference: 1. Gambelunghe G, Stefanetti E, Avenia N, De Feo P. Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients. J Endocr Soc. 2021 May 5;5(7):bvab081. doi: 10.1210/jendso/bvab081. PMID: 34159286; PMCID: PMC8212682. Presentation Date: Saturday, June 17, 2023