THYROID Volume 13, Number 10, 2003 © Mary Ann Liebert, Inc. Ultrasound-Guided Laser Thermal Ablation in the Treatment of Autonomous Hyperfunctioning Thyroid Nodules and Compressive Nontoxic Nodular Goiter Stefano Spiezia, 1 Giovanni Vitale, 2 Carolina Di Somma, 2 Angelo Pio Assanti, 1 Antonio Ciccarelli, 2 Gaetano Lombardi, 2 and Annamaria Colao 2 Objective: Percutaneous laser thermal ablation (LTA) has been applied in several tumors. In this study we eval- uated the safety and long-term efficacy of LTA in the treatment of benign thyroid nodules. Design and patients: Seven patients with autonomous hyperfunctioning thyroid nodule (group A) and five patients with compres- sive nodular goiter (group B) were treated with LTA. Up to three needles were positioned centrally in the thy- roid nodule and laser fiber was placed in the lumen of the needle. Laser illumination was performed reaching a maximal energy deposition of 1800 J per fiber. Measurements: Thyroid nodule volume, endocrinologic, and clinical evaluation were performed at baseline, 3, and 12 months after the treatment. Scintigraphy was per- formed at diagnosis and 12 months after the first session in group A. Results: In group A, mean thyroid vol- ume decreased from 3.15 6 1.26 mL to 0.83 6 0.49 mL (p , 0.001) after 12 months. The treatment induced dis- appearance of clinical signs and symptoms related to hyperthyroidism; normalization of free triiodothyronine (FT 3 ), free thyroxine (FT 4 ), and thyrotropin (TSH) serum levels and recovery of extranodular uptake at scinti- scan. In group B, mean thyroid volume decreased from 11.14 6 4.99 mL to 3.73 6 1.47 mL (p , 0.01) after 12 months. Pressure symptoms in the neck, difficulty in swallowing and tracheal displacement improved in all patients. The treatment was well tolerated in both groups of patients. Conclusions: LTA appears to be a valid and safe alternative approach in the treatment of benign thyroid nodules. 941 Introduction T HYROID NODULE is a common disorder with a prevalence ranging from 5%–50%. This wide range depends on the population studied as well as the sensitivity of detection methods (1,2). Most thyroid nodules are benign lesions. The therapeutic strategy for treatment benign nodules includes several options. Surgery is usually advised in toxic or if ma- lignant nodular goiter is suspected, in large nodules (. 3 cm in diameter) with pressure symptoms, or in nodular goiter for cosmetic concerns (3,4). Radioiodine is a simple, cost-ef- fective, and safe procedure in the treatment of autonomously hyperfunctioning thyroid nodule (5,6). In addition, radioio- dine may be recommended to treat large, nontoxic multi- nodular goiters in patients who decline surgery or who are at high surgical risk (7). Medical therapy includes levothy- roxine therapy at thyrotropin (TSH)-suppressive doses and thionamides. Levothyroxine-suppressive therapy is indi- cated in young patients with small solid cold nodules and normal thyroid function (8,9). Thionamides can normalize free triiodothyronine (FT 3 ), free thyroxine (FT 4 ), and TSH concentrations in toxic nodules. These agents are used to in- duce euthyroidism before definitive therapy is performed (10). Percutaneous intranodular ethanol injection (PEI) has been described by several authors as alternative treatment of toxic thyroid nodules, cysts, and large nontoxic thyroid nodules (11–28). Several authors have recently proposed interstitial laser thermal ablation (LTA) as a new therapeutic method for thy- roid nodules (29,30). It is a minimally invasive interventional procedure able to induce thyroid tissue ablation. We herein report the results of a preliminary study undertaken to assess safety and usefulness of LTA treat- ment in patients affected by single autonomous hyper- functioning thyroid nodule and in euthyroid patients with compressive nodular goiter, evaluating the effects of this therapy on nodule volume, biochemical and clinical benefit. 1 Department of Surgery, Ultrasound Guided & Neck Pathologies Surgery Unit, “S. Maria del Popolo degli Incurabili” Hospital ASL NA1, Naples, Italy. 2 Department of Clinical and Molecular Endocrinology and Oncology, “Federico II” University of Naples, Naples, Italy.