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

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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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

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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.

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Authors and Affiliations

  1. Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China

    Brian Hung-Hin Lang

  2. Department of Medicine, The University of Hong Kong, Hong Kong SAR, China

    Yu-Cho Woo

  3. Department of Radiology, The University of Hong Kong, Hong Kong SAR, China

    Keith Wan-Hang Chiu

Authors
  1. Brian Hung-Hin Lang
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  2. Yu-Cho Woo
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  3. Keith Wan-Hang Chiu
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Corresponding author

Correspondence to Brian Hung-Hin Lang.

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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

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Lang, B.HH., Woo, YC. & Chiu, K.WH. Two-year outcomes of single-session high-intensity focused ultrasound (HIFU) treatment in persistent or relapsed Graves’ disease. Eur Radiol 29, 6690–6698 (2019). https://doi.org/10.1007/s00330-019-06303-8

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  • DOI: https://doi.org/10.1007/s00330-019-06303-8

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