Laser (Light Amplification by Stimulated Emission of Radiation) is an intense beam of light that produce heat at very high temperatures. In laser, the beam of light is transferred via thin fibers and the generated heat destroys the cells in the target tissue. This feature of laser has been widely used in medicine for the treatment of varicose veins, vascular malformations and the tumors of the prostate, breast and liver.
Laser ablation of a thyroid nodule was first reported by Dr Dosing et al in 2002. One year later, the same investigator successfully treated a toxic nodule, and the thyroid hormones returned to normal shortly after the procedure. Since then, laser ablation has become the first line therapy in many centers for the treatment of toxic and nontoxic solitary thyroid nodules.
How is it performed?
After the nodule to be treated is visualized on ultrasound, the skin is numbed and a thin needle is placed into the nodule under ultrasound guidance. A laser fiber is then advanced through the needle into the nodule and the laser machine is activated, which produces heat at the tip of the fiber. By moving the fiber and needle continuously, (moving shot technique), the nodule is completely destroyed with laser energy. After the ablation, the needle and fiber are removed and the patient is discharged after one hour observation.
Which nodules are suitable for laser ablation?
Laser is the most commonly used ablation technique in benign solid thyroid nodules. It has proved to be successful in both toxic and toxic nodules. A recent study on 1837 laser ablations reported that after the ablations, the nodules shrinked by 72%, symptoms such as shortness of breath and swallowing difficulty disappeared and the cosmetic appearance improved significantly. Major complications such as bleeding under the skin and temporary voice changes occurred in only 1% of the patients.
Like alcohol ablation, laser ablation has also been successfully used in the recurrent lymph node metastases of papillary carcinomas. It has also been tested in the ablation of low risk papillary carcinomas, but the long term results of this technique is currently not very well known.
What are the advantages of laser ablation?
Like alcohol ablation, laser ablation is also done with a thin needle. It is performed with local anesthesia under ultrasound guidance. The laser creates no scar on the neck, and the patient can go home shortly after the procedure.
In our patient with a 38x24x27 mm toxic thyroid nodule, percutaneous laser ablation was performed to the nodule. One year after the treatment, the patient became asymptomatic, her thyroid hormone levels returned to normal and the volume of the nodule has reduced by 85%.
In our patient with a 51x30x37 mm solid nodule, percutaneous laser ablation was done under ultrasound guidance. One year later, the treated nodule has showed 80% volume reduction.
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