Laser ablation for thyroid nodules has come to age—a review

Abstract: Benign thyroid nodules are traditionally treated with thyroidectomy when they become symptomatic. Surgery is expensive, results in scarring, and frequently requires subsequent thyroid hormone replacement. For these reasons, in 2000, a feasibility study proposed ultrasound (US)-guided laser ablation (LA) as a minimally invasive treatment for thyroid lesions. During the following 20 years, US-guided thermal ablation techniques performed with laser, radiofrequency, microwaves, and high-intensity focused US have become available for clinical practice. Clinical outcomes have demonstrated a nearly similar efficacy and safety of these techniques, but LA still appears as the less complicated and invasive procedure. LA results, in most cases, in a clinically significant volume decrease paralleled by improvement of local symptoms. Volume reduction is stable over the years, complications are rare, and cosmetic damage or thyroid function changes are nearly absent. LA may also be considered for small size hyperfunctioning thyroid nodules. In these cases, thyroid function normalization may be obtained with no irradiation or chance of hypothyroidism. Due to the efficacy and minimal cost of ethanol injection LA remains as a second-line treatment for cystic lesions which relapse after US-guided ethanol ablation. The use of LA and other minimally invasive techniques for non-surgical management of papillary thyroid microcarcinoma (PTMC) represents a rapidly evolving area. Currently, LA may be considered for patients with low-risk PTMC, mainly if they are surgically at risk, with short life expectation, and if they refuse surgery or active surveillance.