Abstract

Objective: Since it is unclear whether clinical parameters can independently predict the subsequent treatment response following high intensity focused ultrasound (HIFU) ablation of benign thyroid nodules, we aimed to examine clinical factors that may independently predict 12-month efficacy after HIFU treatment.

Methods: One hundred and forty patients who had single ablation were categorized into two groups, those with 12-month nodule shrinkage above the median (Group I, n = 70) and with shrinkage below or equal to the median (Group II, n = 70). Baseline characteristics, treatment parameters, percentage change in serum TSH, Free thyroxine (FT4) and thyroglobulin (Tg) from baseline to Day 4 and appearance of microbubbles (hyperechoic marks (HEMs)) during treatment were compared between groups. To determine independent factors, a multivariate analysis was done by logistic regression analysis.

Results: Baseline characteristics and treatment parameters were comparable between groups. However, on Day-4, group I had significantly lower serum TSH (0.49mIU/L vs. 0.84mIU/L, p = 0.011) and higher FT4 (22.11 pmol/L vs. 18.47 pmol/L, p = 0.008) than group II. The percentage change in TSH, FT4 and Tg were significantly greater in group I (p = 0.002, p = 0.009 and p = 0.001 respectively). The proportion of HEMs observed during treatment was also significantly higher in group I (42.69% vs. 31.72%, p = 0.030). Among the significant factors, the percentage change in FT4 was the only independent factor for 12-month shrinkage (OR = 1.018, 95%CI =1.003–1.032, p = 0.017).

Conclusions: Percentage change in serum FT4 on post-treatment Day-4 was an independent blood parameter for the subsequent nodule shrinkage at 12 months. This finding could potentially facilitate the decision for earlier retreatment of treated nodules.

摘要

目的：由于尚不清楚临床参数是否可以独立预测甲状腺良性结节的高强度聚焦超声（HIFU）消融后的后续治疗反应，因此我们旨在研究可独立预测HIFU治疗后12个月疗效的临床因素。

方法：将140例单次消融的患者分为两组，结节缩小12个月高于中值（I组，n  = 70），并且缩小低于或等于中值（II组，n  = 7）。 70）。比较两组之间基线特征，治疗参数，血清TSH，游离甲状腺素（FT4）和甲状腺球蛋白（Tg）从基线到第4天的百分比变化以及治疗期间微泡的出现（高回声标记（HEM））。为了确定独立因素，通过逻辑回归分析进行了多元分析。

结果：各组之间基线特征和治疗参数可比。但是，在第4天，第一组的血清TSH（0.49mIU / L vs. 0.84mIU / L，p  = 0.011）和FT4（22.11 pmol / L vs. 18.47 pmol / L，p  = 0.008）显着降低。第二组。I组中TSH，FT4和Tg的百分比变化显着更大（分别为p  = 0.002，p  = 0.009和p  = 0.001）。I组在治疗期间观察到的HEM比例也显着更高（42.69％比31.72％，p  = 0.030）。在重要因素中，FT4的百分比变化是12个月收缩的唯一独立因素（OR = 1.018，95％CI = 1.003-1.032，p = 0.017）。

结论：治疗后第4天血清FT4的百分比变化是随后12个月结节缩小的独立血液参数。这一发现可能有助于更早决定治疗结节的决定。