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



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).


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.


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).


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.


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



Anti-thyroid drug


Body mass index




Free T4


Graves’ disease


High-intensity focused ultrasound


Radioactive iodine


Thyroid-stimulating hormone or thyrotropin


Thyroid-stimulating hormone receptor




Visual analogue scale



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.


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


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.


• Retrospective

• Observational

• Single institution


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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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