Interstitial laser photocoagulation (ILP) of benign cystic thyroid nodules--a prospective randomized trial

Abstract

Context: Recurrence rate, after aspiration, in cystic thyroid nodules is very high. Interstitial laser photocoagulation (ILP) is a minimally invasive procedure that reduces the need for surgery in patients with a benign solid thyroid nodule.

Objective: The aim of the study was to evaluate the efficacy of ILP on remission rates in recurrent, predominantly cystic thyroid nodules.

Design and methods: Forty-four consecutive outpatients with a symptomatic, recurrent, and cytologically benign cystic (cyst volume ≥ 2 mL) thyroid nodule were randomized to a single aspiration with (n = 22) or without (n = 22) subsequent ILP and followed up after 1, 3, and 6 months.

Results: Successful outcome (cyst volume ≤ 1 mL) was obtained in 15 of 22 (68%) patients in the ILP group, compared to 4 of 22 (18%) in the aspiration group (P = .002). In the ILP group, the solid part of the nodule was reduced from a median of 1.8 to 1.0 mL (P = .02). In the aspiration-alone group, neither the cyst volume nor the solid nodule volume was significantly reduced. The reduction in median visual analog score (0-10 cm) for pressure symptoms was significantly higher in the ILP group (from 3.0 to 0.0 cm) than in the aspiration-alone group (from 4.0 to 3.5 cm) (P = .006, between groups). No major side effects occurred, and thyroid function was unaffected throughout.

Conclusions: US-guided aspiration and subsequent ILP of benign recurrent predominantly cystic thyroid nodules is safe. It significantly reduces recurrence rate, the volume of the solid nodule component, and pressure symptoms. ILP constitutes an important alternative to surgery in such patients.