Objective: Percutaneous laser ablation (PLA) is a new procedure utilized to decrease nodule volume in symptomatic thyroid nodules, to provide euthyroidism in autonomous hyperfunctioning nodules, and to decrease compressive symptoms palliatively in malignant nodules. Standard treatment in autonomous thyroid nodules is radioiodine and surgery. In this report, we aimed to present this case to demonstrate changes in nodule histopathology, which was undergone thyroidectomy two years after PLA procedure.
Case report: We applied PLA in a 25-year-old woman with euthyroid solitary autonomous thyroid nodule due to compression symptoms. A total of 3000 J of energy was applied in 600 s with a power of 5 W in single session. Initial nodule volume was 13.50 ml, which regressed to 4.20 ml within 6 months. However, nodule size began to grow at 9th month, and became 6.50 ml in 1 year. Nodule volume increased to 10 ml at second year of procedure, and compression symptoms reappeared. Thyroidectomy was performed two years after PLA. Macroscopically, thyroidectomy material revealed a whitegray area at the procedure site. Microscopically, there was minimal fibrosis, scarce amounts of old hemorrhagic findings, and multiple microfollicular structures containing colloid in their lumen. Lymphocyte infiltration was observed in thyroid tissue surrounding the nodule.
Conclusion: We did not observe any histopathologic effect of laser on thyroid tissue except lymphoid infiltration. This is the most important histopathologic finding indicating that PLA procedure was a minimally invasive and reliable technique. These are the first long-term data of histopathologic effects of PLA in a benign thyroid nodule which tended to re-grow after procedure. According to these data, PLA application on thyroid nodules is considered safe in long-term.
03 - 07 May 2008
European Society of Endocrinology