Endocrine Abstracts

Laser ablation of thyroid nodules has been used for the last two decads (Pacella et al, 2000). Surprisingly, complications are less frequent in patients treated without anesthesia, probably because eventual pain is an useful alarm symptom, leading the operator to repositioning the fiber during the procedure (Pacella et al., 2015).

Material and methods: A total of 32 patients were included, without using local anesthesia. Nodules were solid, 5–72 ml volume, age 36–84 years, gender female (84%). Procedure included three phases: (1) Preparation 30 min (informed consent and final decision about anatomic approach); (2) Laser ablation 30 min (usually 3–8 paths, 3–5 illuminations each and total energy of 50–500 joules/cc); and (3) Observation 60 min (with ice collar and vital constants monitoring). A 1064 nm Nd-YAG laser from an EchoLaser generator (Elesta, Florencia-Italy) was used. Triple thyroid image (Ultrasound, Doppler and Elastography) was monitored using an Acusson 2000 Hellix platform (Siemens, Forchheim-Germany).

Results: 30 of 32 patients (93.75%) would accept another ablation if necessary. Pain was refered as 1–6 of 10 (arithmetic mean 3.5; median 2). Difficulties were: cervical discomfort (4), excessive time of manipulation because short neck (1), transient mild hypertension (1), mild vasovagal reaction (1), small intra-thyroid hematoma (1) and a partial and transient Horner syndrome (1) resolved 3 months later.

Discussion: Clinical tolerance in general was spectacular. Major complaints were postural. Complications were mild and transient, although potentially risky. No cases of severe pain, voice change, fever, skin burn or cough were observed. In the future, preventive specific strategies (like careful identification of risky patients, laser cauterization of large feeding vessels or protective hydrodissection to protect vital organs) will be considered before laser ablation.

Conclusions: Clinical tolerance was very good. Complications were few, mild and transient, but potentially risky. This highlights the importance of identifying properly risky patients as well as the need of including preventive strategies.