Objective: Laser therapy (LT) is considered a safe and effective procedure for inducing thyroid nodule necrosis, fibrosis and shrinkage. Little is known about long-term efficacy of LT in benign complex thyroid nodules, which we report here.
Design and methods: One hundred and ten euthyroid outpatients [28 men and 82 women; median age 48 years (range 17-82)] with a recurrent cytologically benign cystic (≥ 2 ml cyst-volume) thyroid nodule causing local discomfort were assigned to LT. LT was performed after complete cyst aspiration and under continuous ultrasound (US)–guidance. Nineteen patients (17 within 6 months) had surgery after LT. The median follow-up for the remaining 91 patients was 45 months (range; 12-134).
Results: The overall median nodule volume in the 110 patients decreased from 9.0 ml (range; 2.0–158.0) to 1.2 ml (range; 0.0-85.0) (p<0.001) at the final evaluation, corresponding to a median reduction of 85% (range; -49% to 100%). Remission of the cystic part (volume ≤ 1 ml) was obtained in 82 of 110 (75%) patients after LT. The median cyst volume decreased from 6.3 ml (range; 2.0-158.0) to 0.0 ml (range; 0.0-85.0) (p<000.1), corresponding to a median reduction of 100% (range; -49%-100%). These results correlated with a significant decrease in pressure as well as cosmetic complaints. Side effects were restricted to mild local pain.
Conclusion: US-guided aspiration and subsequent LT of benign recurrent cystic thyroid nodules results in a satisfactory long-term clinical response in the majority of patients. LT constitutes a clinically relevant alternative to surgery in such patients.