Localized Thyroid Tissue Ablation by High Intensity Focused Ultrasound: Volume Reduction, Effects on Thyroid Function and Immune Response

Abstract

Purpose: The aim of this study was to assess the effectiveness of high intensity focused ultrasound (HIFU) in reducing thyroid nodule volume while preserving thyroid function as measured by immunological response.

Materials and Methods: 12 patients (9 females) whose average age was 56.9 years (37 – 81) were treated with HIFU in an ambulatory setting. All patients had a single benign thyroid nodule treated in one HIFU session. The median nodular outline volume (NOV) was 3.4 ml (range 0.6 – 5.0 ml). The therapeutic ultrasound probe (Echopulse^® THC900 888-H) used works with a frequency of 3 MHz, reaching temperatures of 80 – 90° C and a mean output between 87.6 and 192.8 W. To assess possible effects of HIFU on thyroid function, serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobulin (hTg) and antibodies against thyroglobulin (TAbs), thyrotropin receptors (TRAbs) and thyroid peroxidase (TPOAbs) were measured at enrollment, 24-hours post-HIFU treatment and at 3-month follow-up.Pre- post thyroglobulin reduction was measured to evaluate the success of ablation and the nodular outline volume (NOV) was evaluated at baseline and the 3-month follow-up to assess effectiveness.

Results: All measured hormone levels were within normal ranges and remained stable (p > 0.05). No clinically meaningful immune reaction was induced (p > 0.05). Thyroglobulin serum levels increased significantly at 24 hours after ablation (p < 0.05) and decreased significantly at the 3-month follow-up (p < 0.05), returning to pre-ablative levels. The median reduction in nodular outline volume (NOV) was 55 % (p < 0.05).

Conclusion: HIFU is a safe and effective alternative for treating benign thyroid nodules, while preserving thyroid function. Further investigations with multiple treatments should be conducted to evaluate whether additional treatments can achieve greater volume reduction.

Key points:

• HIFU is a safe and effective method to treat thyroid nodules.

• HIFU does not interfere with thyroid gland function.

• HIFU does not induce any immune response like Graves’ disease.

Citation Format:

• Korkusuz H, Sennert M, Fehre N et al. Localized Thyroid Tissue Ablation by High Intensity Focused Ultrasound: Volume Reduction, Effects on Thyroid Function and Immune Response. Fortschr Röntgenstr 2015; 187: 1011 – 1015

Zusammenfassung

Ziel: Das Ziel dieser Studie war, die Effektivität von hochintensivem fokussiertem Ultraschall (HIFU) zu beurteilen. Es wurden die Volumenreduktion der Knoten, die Funktion der Schilddrüse und eventuell auftretende Immunreaktionen evaluiert.

Material und Methoden: Zwölf Patienten (neun weiblich, Durchschnittsalter 56,9 Jahre) wurden ambulant mit HIFU an der Schilddrüse behandelt. Alle Patienten hatten einen einzelnen benignen Schilddrüsenknoten, der in jeweils einer Therapiesitzung behandelt wurde. Das mittlere Knotenvolumen (nodular outline volume) betrug 3,4 ml (Bereich 0,6 – 5,0 ml). Die therapeutische Ultraschallsonde (Echopulse^® THC900 888-H), die in dieser Studie verwendet wurde, arbeitet mit einer Frequenz von 3 MHz, erreicht eine mittlere Temperatur von 80 – 90 °C und sendet eine mittlere akustische Leistung von 87,6 bis 192,8 Watt aus. Die Serumspiegel von Trijodthyronin (T3), Thyroxin (T4), Thyreotropin (TSH), Thyreoglobulin (hTg) und zusätzlich Antikörper gegen Thyreoglobulin (TAK), Thyreotropin-Rezeptoren (TRAK) und Thyreoperoxidase (TPO) wurden bei der Aufnahme, 24 Stunden nach der Therapie und drei Monate nach der Therapie gemessen. Die prä-post Thyreoglobulin-Reduktion wurde gemessen, um den Erfolg der Ablation einzuschätzen. Außerdem wurde das Knotenvolumen mit der Variable Nodular Outline Volume (NOV) untersucht, um die Effektivität zu bestimmen.

Ergebnisse: Die Hormonspiegel sind stabil geblieben (p < 0,05). Es wurde keine Autoimmunerkrankung, wie etwa eine Autoimmunthyreoditis hervorgerufen (p > 0,05). Die Serumthyreoglobulinspiegel sind 24 Stunden nach der Ablation signifikant angestiegen (p > 0,05). 3 Monate nach der Ablation wiederum sind sie signifikant abgefallen (p < 0,05) und erreichten das prä-ablative Niveau. Das mittlere Knotenvolumen (NOV) konnte um 55 % reduziert werden (p < 0,05).

Schlussfolgerung: HIFU ist eine sichere und effektive Methode, um benigne Schilddrüsenknoten zu behandeln. Die Funktion der Schilddrüse wird nicht beeinträchtigt. Um eine noch größere Volumenreduktion zu erreichen, könnten mehrfache Sitzungen Erfolg versprechen.

Kernaussagen:

• HIFU ist eine sichere und effektive Methode, um benigne Schilddrüsenknoten zu behandeln.

• HIFU beeinträchtigt die Funktion der Schilddrüse nicht.

• HIFU induziert keine ernste Immunreaktion, wie etwa Morbus Basedow.

Key words

high intensity focused ultrasound - thyroid nodule - thermal ablation - thyroid hormones - thyroid function - thyroglobulin

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