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European Radiology

, Volume 29, Issue 12, pp 6690–6698 | Cite as

Two-year outcomes of single-session high-intensity focused ultrasound (HIFU) treatment in persistent or relapsed Graves’ disease

  • Brian Hung-Hin LangEmail author
  • Yu-Cho Woo
  • Keith Wan-Hang Chiu
Ultrasound

Abstract

Objective

To evaluate the longer-term disease relapse of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation as a treatment for persistent/relapsed Graves’ disease (GD).

Methods

After ethics approval, consecutive patients with persistent or relapsed GD who underwent bilateral US-guided HIFU ablation from 2016 to 2017 were retrospectively analyzed. Altogether, 75 patients received HIFU ablation of the central portion of the right and left thyroid lobes with areas near the trachea–esophageal groove and common carotid artery un-ablated. They were followed for 24 months or longer. Baseline thyrotropin (TSH), free T4, anti-thyroid autoantibodies, and TSH receptor (TSHR) antibody were checked. Primary outcome was the 24-month relapse rate. Relapse referred to hyperthyroidism (free T4 (FT4) > 23 pmol/L) afterwards. Variables associated with relapse were analyzed by binary logistic regression.

Results

The cohort comprised mostly females (84.0%) with a mean age of 42.05 ± 10.74 years. The 24-month relapse rate was 41.3% with 31 patients suffering a relapse. No patient suffered from hypothyroidism. Three patients (4.0%) suffered from temporary vocal cord palsy but these injuries recovered spontaneously after 2 months. In univariate analysis, higher daily dose of carbimazole (OR = 1.125, 95% CI = 1.023–1.237, p = 0.015) and higher baseline TSHR level (OR = 1.085, 95% CI = 1.022–1.152, p = 0.007) were significant factors for disease relapse. In the multivariate analysis, higher baseline TSHR level was a significant independent factor for disease relapse within 24 months (OR = 1.079, 95% CI = 1.014–1.148, p = 0.016).

Conclusions

US-guided HIFU of the thyroid gland was a safe and relatively efficacious treatment in the longer term for patients with persistent or relapsed GD.

Key Points

US-guided HIFU ablation is relatively efficacious in the longer term.

US-guided HIFU ablation of the thyroid is safe.

Higher TSHR level may lead to higher disease relapse after treatment.

Keywords

Interventional ultrasonography High-intensity focused ultrasound ablation Graves’ disease Thyrotoxicosis Ablation techniques 

Abbreviations

ATD

Anti-thyroid drug

BMI

Body mass index

CMZ

Carbimazole

FT4

Free T4

GD

Graves’ disease

HIFU

High-intensity focused ultrasound

RAI

Radioactive iodine

TSH

Thyroid-stimulating hormone or thyrotropin

TSHR

Thyroid-stimulating hormone receptor

US

Ultrasonography

VAS

Visual analogue scale

Notes

Acknowledgments

We would like to thank Mr. Yu Ming Sing and Ms. Li Wing Kar for their help with reminding patients for follow-up visits and clinical data collection.

Funding

This study was supported by Health and Medical Research Fund (ref no.: HMRF#04150716), the Food and Health Bureau, the Government of the Hong Kong Special Administrative Region.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor Stephen Cheng (Head of Department).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Single institution

References

  1. 1.
    Nyström HF, Jansson S, Berg G (2013) Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003-2005. Clin Endocrinol (Oxf) 78(5):768–776CrossRefGoogle Scholar
  2. 2.
    Ross DS, Burch HB, Cooper DS et al (2016) 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 26(10):1343–1421CrossRefGoogle Scholar
  3. 3.
    Brito JP, Schilz S, Singh Ospina N et al (2016) Antithyroid drugs-the most common treatment for Graves’ disease in the United States: a nationwide population-based study. Thyroid 26(8):1144–1145CrossRefGoogle Scholar
  4. 4.
    Bartalena L, Burch HB, Burman KD, Kahaly GJ (2016) A 2013 European survey of clinical practice patterns in the management of Graves’ disease. Clin Endocrinol (Oxf) 84:115–120CrossRefGoogle Scholar
  5. 5.
    Burch HB, Burman KD, Cooper DS (2012) A 2011 survey of clinical practice patterns in the management of Graves’ disease. J Clin Endocrinol Metab 97:4549–4558CrossRefGoogle Scholar
  6. 6.
    Lang BH, Woo YC, Wong CKH (2017) High intensity focused ultrasound (HIFU) treatment for symptomatic benign thyroid nodules: a prospective study. Radiology 284(3):897–906CrossRefGoogle Scholar
  7. 7.
    Lang BHH, Woo YC, Chiu KW (2018) Sequential high intensity focused ultrasound (HIFU) ablation in the treatment of benign multinodular goitre: an observational retrospective study. Eur Radiol 28(8):3237–3244CrossRefGoogle Scholar
  8. 8.
    Lang BH, Woo YC, Wong IY, Chiu KW (2017) Single-session high-intensity focused ultrasound treatment for persistent or relapsed Graves disease: preliminary experience in a prospective study. Radiology 285(3):1011–1022CrossRefGoogle Scholar
  9. 9.
    Zimmermann M, Saad A, Hess S, Torresani T, Chaouki N (2000) Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency. Eur J Endocrinol 143(6):727–731CrossRefGoogle Scholar
  10. 10.
    Palit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165CrossRefGoogle Scholar
  11. 11.
    Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY (2013) A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 154(6):1158–1164CrossRefGoogle Scholar
  12. 12.
    De Leo S, Lee SY, Braverman LE (2016) Hyperthyroidism. Lancet 388(10047):906–918CrossRefGoogle Scholar
  13. 13.
    Aung ET, Zammitt NN, Dover AR, Strachan MWJ, Seckl JR, Gibb FW (2019) Predicting outcomes and complications following radioiodine therapy in Graves’ thyrotoxicosis. Clin Endocrinol (Oxf) 90(1):192–199CrossRefGoogle Scholar
  14. 14.
    Lang BHH, Woo YC, Chiu KW (2017) Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors. Int J Hyperthermia 33(8):888–894PubMedGoogle Scholar
  15. 15.
    Bini F, Trimboli P, Marinozzi F, Giovanella L (2018) Treatment of benign thyroid nodules by high intensity focused ultrasound (HIFU) at different acoustic powers: a study on in-silico phantom. Endocrine 59(3):506–509CrossRefGoogle Scholar
  16. 16.
    Lang BHH, Woo YC, Chiu KW (2018) Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 28(6):2675–2681CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Surgery, Queen Mary HospitalThe University of Hong KongHong Kong SARChina
  2. 2.Department of MedicineThe University of Hong KongHong Kong SARChina
  3. 3.Department of RadiologyThe University of Hong KongHong Kong SARChina

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