Thyroid Nodules

Background

Clinical KeyThyroid nodules are lumps that form in the thyroid gland. In many cases they are benign, but they can be the first sign of thyroid cancer.

According to the National Cancer Institute, thyroid cancer was expected to account for more than 60,000 new cases and over 1,800 deaths each year. It is more common in women than in men. In many cases, thyroid cancer can be cured. Factors contributing to thyroid nodules include iodine deficiency, inflammation, overgrowth of normal thyroid tissue, or malignancies. The exact causes underlying thyroid cancer are not known, but risk factors include genetic conditions, a family history of thyroid cancer, Asian ancestry, and exposure to radiation in the head and neck.

Current Treatment

Treatment options for thyroid nodules include careful monitoring, surgery, and radioactive iodine. Radiation, chemo-, hormone, and targeted therapy are additional options if nodules prove to be cancerous.

Focused Ultrasound Treatment

Focused ultrasound allows the physician to direct a focused beam of acoustic energy to destroy the tumor without harming adjacent tissue. Focused ultrasound is completely non-invasive, and it is performed while the patient is awake. A follow-up imaging and blood test can determine whether the entire tumor has been removed; if necessary, focused ultrasound can be repeated. Focused ultrasound may offer the following benefits in treating thyroid nodules:

  • It is non-invasive and therefore may be associated with fewer complications such as infection or scarring of the neck.
  • It involves a shorter recovery time; thus patients can return to work and normal activities more quickly.
  • Because it does not use ionizing radiation, it can be repeated as needed.

Initial reports on US-guided focused ultrasound for benign solid thyroid nodules have shown significant size and volume reductions at 6 months. Nodules with increased blood flow showed less volume reduction than the less-vascularized nodules displayed. The conclusion was that early data shows US-guided focused ultrasound to be safe and effective for benign, solid thyroid nodules.

Clinical Trials

At present, there is one clinical trial evaluating focused ultrasound for the treatment of thyroid nodules, being carried out at the Sofia Endocrinology University Hospital in Bulgaria. Sofia – Endocrinology University Hospital "Ivan Penchev Academia" (Bulgaria)

Contact information:
University Hospital of Endocrinology »Acad. Ivan Penchev »
Department of Thyroid and Mineral Bone Diseases 2,
Zdrave Street - 1431 Sofia – Bulgaria
Secretariat: + 359 (0) 2 895 62 21
Contact: Pr. Roussanka Kovatcheva via email at

Regulatory & Reimbursement

The Echopulse system manufactured by Theraclion is appoved in Europe for treating thyroid nodules. Some European insurance companies are paying for focused ultrasound treatment of thyroid nodules.

Notable Papers

Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F. Localized Thyroid Tissue Ablation by High Intensity Focused Ultrasound: Volume Reduction, Effects on Thyroid Function and Immune Response. Rofo. 2015 Nov;187(11):1011-5. doi: 10.1055/s-0035-1553348.

Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K. Benign Solid Thyroid Nodules: US-guided High-Intensity Focused Ultrasound Ablation-Initial Clinical Outcomes. Radiology. 2015 Aug;276(2):597-605. doi: 10.1148/radiol.15141492.

Korkusuz H, Fehre N, Sennert M, Happel C, Grünwald F. Volume reduction of benign thyroid nodules 3 months after a single treatment with high-intensity focused ultrasound (HIFU). J Ther Ultrasound. 2015 Mar 4;3:4. doi: 10.1186/s40349-015-0024-9.

Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F. Local thyroid tissue ablation by high-intensity focused ultrasound: effects on thyroidfunction and first human feasibility study with hot and cold thyroid nodules. Int J Hyperthermia. 2014 Nov;30(7):480-5. doi: 10.3109/02656736.2014.962626.

Esnault O, Franc B, Ménégaux F, Rouxel A, De Kerviler E, Bourrier P, Lacoste F, Chapelon JY, Leenhardt L. High-Intensity Focused Ultrasound Ablation of Thyroid Nodules: First Human Feasibility Study; Thyroid, Volume 21, Number 9, 2011

Kovatcheva R, Vlahov J, Stoinov J, Kirilov G, Krivoshiev S, Arnaud F, Ortuno C, Drueke T. High-intensity focused ultrasound (HIFU) treatment in uraemic secondary hyperparathyroidism; Nephrology Dialysis Transplantation 2011

Esnault O, Rouxel A, Le Nestour E, Gheron G, Leenhardt L. Minimally Invasive Ablation of a Toxic Thyroid Nodule by High-Intensity Focused Ultrasound; AJNR Am J Neuroradiol (2010)

Click here for additional references from PubMed.

     

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