Abstract
Background: Thyroid nodules are a common disease in endocrine clinical practice. They are often benign, asymptomatic, and do not require any treatment. But, in a non-negligible proportion, they can cause local symptoms of compression or esthetic concerns. In the last two decades, the advent of laser ablation (LA) has become a valid alternative to surgery for these nodules. Moreover, LA has also been successfully used to treat small thyroid cancers and neck recurrence.
Objective: This study aims to review and summarize the published literature regarding LA in the treatment of benign and malignant thyroid nodules.
Methods: A comprehensive literature search on PubMed from 2000 to 2023 was carried out. The search terms included: thyroid, nodules, laser, cancer, lymph node metastasis, and autonomously functioning nodules. The most relevant investigations in the field were selected.
Results: In the last two decades, a very remarkable number of papers consistently demonstrated that LA is able to durably shrink benign nodules on average by about 50%; better results are obtained in spongiform nodules with a volume less than 15 ml; 500 J/ml of tissue should be administered. LA may be a valid option to treat autonomously functioning nodules and papillary thyroid cancers especially if they are <10 mm, and with neck recurrence in patients already submitted to surgery. LA has also been demonstrated to be cost-effective compared to surgical treatment both in benign and malignant lesions, with similar outcomes.
Conclusion: Evidence demonstrated that LA is a valid alternative to surgery in benign and malignant thyroid lesions, but also to obtain a successful treatment, a careful selection of the lesion is mandatory.
Graphical Abstract
[http://dx.doi.org/10.1530/eje.0.1420224] [PMID: 10700715]
[http://dx.doi.org/10.1089/thy.2004.14.926] [PMID: 15671771]
[http://dx.doi.org/10.1210/jc.2015-3100] [PMID: 26465395]
[http://dx.doi.org/10.1001/jama.2015.0956] [PMID: 25734734]
[http://dx.doi.org/10.1155/2014/459791] [PMID: 25538855]
[http://dx.doi.org/10.1089/thy.2023.0263] [PMID: 37265153]
[http://dx.doi.org/10.1080/02656736.2019.1622795] [PMID: 31537159]
[http://dx.doi.org/10.1007/s11154-020-09592-3] [PMID: 32959174]
[http://dx.doi.org/10.1159/000446746] [PMID: 27843808]
[http://dx.doi.org/10.34172/jlms.2020.60] [PMID: 33425286]
[http://dx.doi.org/10.1097/MED.0b013e32830eb89a] [PMID: 18769216]
[http://dx.doi.org/10.1080/02656736.2016.1244707] [PMID: 27701923]
[http://dx.doi.org/10.1007/s00270-021-02915-0] [PMID: 34254175]
[http://dx.doi.org/10.1177/1553350612459276] [PMID: 22991383]
[http://dx.doi.org/10.1159/000508484] [PMID: 32903999]
[http://dx.doi.org/10.1148/radiology.217.3.r00dc09673] [PMID: 11110927]
[http://dx.doi.org/10.4158/EP.10.3.276] [PMID: 15310547]
[http://dx.doi.org/10.1089/thy.2006.0204] [PMID: 17381356]
[http://dx.doi.org/10.1089/thy.2010.0189] [PMID: 20929405]
[http://dx.doi.org/10.1210/jc.2014-1826] [PMID: 25050903]
[http://dx.doi.org/10.1007/s12020-019-02019-3] [PMID: 31327158]
[http://dx.doi.org/10.1089/thy.2020.0202] [PMID: 32578498]
[http://dx.doi.org/10.1210/jendso/bvab081] [PMID: 34159286]
[http://dx.doi.org/10.1080/02656736.2022.2025923] [PMID: 35078372]
[http://dx.doi.org/10.1210/jc.2015-1964] [PMID: 26274342]
[http://dx.doi.org/10.1089/thy.2018.0604] [PMID: 30803397]
[http://dx.doi.org/10.1080/15368378.2020.1809448] [PMID: 32799679]
[http://dx.doi.org/10.1080/02656736.2016.1212279] [PMID: 27405595]
[http://dx.doi.org/10.1007/s12020-023-03403-w] [PMID: 37258994]
[http://dx.doi.org/10.3348/kjr.2019.0798] [PMID: 32410415]
[http://dx.doi.org/10.2174/1871530323666230201104112] [PMID: 36722479]
[http://dx.doi.org/10.1210/jcem-50-6-1089] [PMID: 7372787]
[http://dx.doi.org/10.1530/EJE-07-0094] [PMID: 17609407]
[http://dx.doi.org/10.1080/02656736.2018.1437931] [PMID: 29409365]
[http://dx.doi.org/10.1007/s00330-021-08289-8] [PMID: 34751793]
[http://dx.doi.org/10.1210/jc.2013-2967] [PMID: 24684455]
[http://dx.doi.org/10.1080/02656736.2018.1549335] [PMID: 30556434]
[http://dx.doi.org/10.1371/journal.pone.0179387] [PMID: 28614405]
[http://dx.doi.org/10.1002/ijc.29634] [PMID: 26069163]
[http://dx.doi.org/10.1136/bmj.g3045]
[http://dx.doi.org/10.1001/jamaoto.2020.0368] [PMID: 32297926]
[http://dx.doi.org/10.1089/thy.2010.0447] [PMID: 21595556]
[http://dx.doi.org/10.1089/thy.2013.0279] [PMID: 23978269]
[http://dx.doi.org/10.1007/s00330-016-4610-1] [PMID: 27853812]
[http://dx.doi.org/10.1186/s40644-019-0204-x] [PMID: 30894228]
[http://dx.doi.org/10.1002/lsm.23238] [PMID: 32216112]
[http://dx.doi.org/10.3389/fendo.2022.921812]
[http://dx.doi.org/10.1080/02656736.2019.1649475] [PMID: 31464140]
[http://dx.doi.org/10.1089/thy.2021.0151] [PMID: 34445885]
[http://dx.doi.org/10.1159/000516469] [PMID: 34178704]
[http://dx.doi.org/10.1007/s12020-022-02991-3] [PMID: 35122627]
[http://dx.doi.org/10.1007/s12020-019-02165-8] [PMID: 31865556]
[http://dx.doi.org/10.1210/jc.2012-2991] [PMID: 23150695]
[http://dx.doi.org/10.1007/s00270-016-1313-6] [PMID: 26911732]