RESUMO
BACKGROUND: Hyperactive thyroid nodules (HTN) are usually treated with radioactive iodine (RAI). However, as RAI is associated with a 30-60% long-term risk of permanent hypothyroidism, radiofrequency ablation (RFA) may be a good alternative. Primary aim of this study was to assess the percentage of patients achieving euthyroidism after RFA. PATIENTS AND METHODS: Patients with a symptomatic HTN were treated by ultrasound-guided RFA, using the trans-isthmic approach and moving-shot technique, in an outpatient setting under local anaesthesia. RESULTS: Twenty-one patients were included, ranging in age from 37-75 years. Follow-up was at least one year. All patients had a suppressed serum thyroid-stimulating hormone (TSH), with free thyroxine (FT4) and free triiodothyronine (FT3) concentrations mildly elevated in 33% and 43% of cases, respectively. RFA was not associated with clinically meaningful adverse effects. TSH normalisation was achieved in 11/21 patients (52%) after first RFA. A partial response, defined as a normalisation of FT4 and FT3, but incomplete improvement of TSH, was observed in 6/21 patients (29%). Three patients had no response (14%), and one patient developed mild, asymptomatic subclinical hypothyroidism. Five patients underwent a second RFA and this led to TSH normalisation in four, thereby raising the rate of complete remission to 71%. Recurrence of TSH suppression did not occur during the study period. CONCLUSION: These data suggest that RFA is a safe and promising treatment for symptomatic hyperactive thyroid nodules, with a low risk of permanent hypothyroidism. Long-term studies are needed to identify the recurrence risk of hyperthyroidism.
Assuntos
Hipertireoidismo/terapia , Ablação por Radiofrequência/métodos , Nódulo da Glândula Tireoide/terapia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Assistência Ambulatorial/métodos , Anestesia Local , Feminino , Humanos , Hipertireoidismo/sangue , Hipertireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Testes de Função Tireóidea , Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/complicações , Tireotropina/sangue , Tiroxina/sangue , Resultado do Tratamento , Tri-Iodotironina/sangueRESUMO
A commercially available prepackaged liquid diet was prescribed to 112 patients to use in combination with laxatives in a 1-day preparation regimen before single- and double-contrast barium enema examination. Cleansing enemas were not performed before the examination. Colon radiographs were evaluated with regard to amount of residual stool, mucosal detail, coating, and overall quality. Results were excellent in 92% (103 of 112) of patients and fair in 5% (six of 112). Cleansing enemas can be avoided through use of this preparation protocol.