Repeated laser thermal ablation of a large functioning thyroid nodule restores euthyroidism and ameliorates constrictive symptoms.

A 57-yr-old man was referred for tachycardia, weight loss, throat constraint, and worsening dyspnea. The serum levels of TSH were below 0.05 U/ml, with elevated free T4 (21.2 pg/ml) and normal free T3 (4.1 pg/ml). Ultrasound scan showed a right dominant thyroid nodule (volume, 55 ml) with both periand intranodular intense vascularization pattern. Tracheal deviation and narrowing were shown by magnetic resonance imaging (MRI) (Fig. 1, A and B). The patient refused surgery and/or I ablative therapy, and his compliance to medical treatment was poor. Thus, a minimally invasive interventional procedure was chosen (1). Laser thermal ablation (LTA) constitutes an alternative strategy for the ablation of both hyperfunctioning and nonfunctioning thyroid nodules (1–4). The patient underwent four LTA sessions, each 45 d apart. The ablation procedure was performed under ultrasound guidance by using a 400m bare fiber and a continuous wave diode laser operating at 980 nm. Energy was delivered with an output power of 7 W for a mean total amount of 3000 Joule at each session. Six months later, thyroid hormones and TSH were within the normal range and remained so throughout a 30-month follow-up. MRI performed 10 months later showed an impressive decrease of nodule size (posttreatment volume, 5.0 ml) with significant amelioration of tracheal deviation and narrowing (Fig. 1, C and D). The patient reported an improvement of dyspnea and was satisfied with the cosmetic result. Although side effects have been described (5), LTA can be performed in selected cases on an outpatient basis and may also be effective for functioning large thyroid nodules. Acknowledgments