The percentage of serum thyroglobulin rise in the first-week did not predict the eventual success of high-intensity focussed ablation (HIFU) for benign thyroid nodules

Abstract

Background: Given that high-intensity focussed ultrasound (HIFU) of benign thyroid nodules often causes a massive release of thyroglobulin (Tg) into the circulation, we hypothesised a greater initial Tg rise may result in a greater nodule shrinkage 6 months after ablation.Methods: One hundred and five patients who underwent HIFU for symptomatic benign thyroid nodule from 2015 to 2016 were analysed. Serum Tg and anti-Tg autoantibody were checked on treatment day (baseline) and 4 d after treatment. The % of Tg rise = [serum Tg on day-4 – baseline serum Tg]/[baseline serum Tg] * 100 while the nodule shrinkage as measured by volume reduction ratio (VRR) = [baseline volume – volume at 6-month]/[baseline volume] * 100. Treatment success was defined as VRR >50%.Results: At 6-month, the mean VRR was 62.2 ± 25.0% and 59 (76.6%) patients had treatment success. The mean baseline Tg level increased from 292.8 ± 672.7 ng/mL to 2022.7 ± 1759.8 ng/mL in the first-week. The % of Tg rise did not significantly correlate with either 3-month or 6-month VRR (p = 0.920 and p = 0.699, respectively). The mean % of Tg rise in the first week was not different between those with and without 6-month treatment success (368.2% vs. 1068.7%, p = 0.381). No clinical factors significantly correlated with treatment success.Conclusions: There was an almost seven-fold increase in the mean Tg level 4 d after HIFU ablation. The % of Tg rise in the first week did not appear to correlate with the 6-month nodule shrinkage or treatment success.