Ultrasound-guided interstitial laser photocoagulation of an autonomous thyroid nodule:: The introduction of a novel alternative

Radioiodine (I-131) and surgery are the standard therapeutic options for the solitary autonomous thyroid nodule (AFTN). Percutaneous ethanol injection (PEI) has proven to be an effective technique and possible alternative to the conventional treatment options. However, PEI is not devoid of side effects and often necessitates multiple treatment sessions. We present a case of a 17-year-old female successfully treated with ultrasound (US)-guided percutaneous interstitial laser photocoagulation (ILP) for an AFTN. Initially, she had a serum thyrotropin (TSH) of 0.01 mU/L and normal peripheral thyroid hormone levels. Scintigraphically it was a hot nodule with suppression of extranodular uptake, and ultrasonographically it was a solitary solid 8.2-mL nodule. One treatment session (3 W for 650 seconds [1950 J]) normalized serum thyrotropin (TSH) level within 2 months and decreased the nodule volume to 4.9 mL (40% reduction) without further alterations during an additional 9 months of follow-up. Side effects were transient thyrotoxicosis and local pain as seen with PEI. To our knowledge, this is the first reported case of ILP used in a patient with a pretoxic thyroid nodule. US-guided thermic tissue coagulation with ILP could become a useful alternative for the AFTN in patients who cannot or will not undergo surgery or treatment with I-131.