Laser Ablation and 131-Iodine: A 24-Month Pilot Study of Combined Treatment for Large Toxic Nodular Goiter

Context: It is normally recognized that the preferred treatment in large toxic thyroid nodules should be thyroidectomy. Objective: The aim of the study was to assess the efficacy of combined laser ablation treatment (LAT) and radioiodine 131 (131I) treatment of large thyroid toxic nodules with respect to rapidity of control of local symptoms, of hyperthyroidism, and of reduction of administered 131I activity in patients at refusal or with contraindications to surgery. Design and Setting: We conducted a pilot study at a single center specializing in thyroid care. Patients: Fifteen patients were treated with LAT, followed by 131I (group A), and a series of matched consecutive patients were treated by 131I only (group B). Intervention(s): Laser energy was delivered with an output power of 3 W (1800 J per fiber per treatment) through two 75-mm, 21-gauge spinal needles. Radioiodine activity was calculated to deliver 200 Gy to the hyperfunctioning nodule. Main Outcome Measure(s): Thyroid function, thyroid peroxidase antibody, thyroglobulin antibody, ultrasound, and local symptoms were measured at baseline and up to 24 months. Results: Nodule volume reduction at 24 months was: 71.3 +/- 13.4 vs 47.4 +/- 5.5%, group A (LAT + 131I) vs group B (131I), respectively; P < .001). In group A (LAT + 131I), a reduction in radio-iodine-administered activity was obtained (-21.1 +/- 8.1%). Local symptom score demonstrated a more rapid reduction in group A (LAT + 131I). In three cases, no 131I treatment was needed after LAT. Conclusions: In this pilot study, combined LAT/131I treatment induced faster and greater improvement of local and systemic symptoms compared to 131I only. This approach seems a possible alternative to thyroidectomy in patients at refusal of surgery.