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Medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation

  • Clinical Management of Endocrine Diseases
  • Published:
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Abstract

Purpose

Minimally invasive image-guided thermal ablation has been proposed as alternative to surgery for treatment of benign thyroid nodules and recurrent differentiated thyroid carcinoma. Here, we report for the first time the use of radiofrequency ablation (RFA) in a patient with non-metastatic medullary thyroid carcinoma (MTC) who did not undergo surgery due to high anesthesiological risk.

Methods and results

A 64-year-old woman was referred to our institution for a routine endocrinological visit. No thyroid-related symptoms were present. She had a history of metabolic, cardiovascular and neurological diseases. On clinical examination, a nodular lesion of about 10 mm was palpable in the right thyroid lobe; ultrasonography (US) confirmed the presence of a 13 mm thyroid nodule in the lower pole of the right lobe, that was hypoechoic and with regular margins. Serum calcitonin (Ctn) level was significantly high (647 pg/mL). Fine-needle aspiration (FNA) of the thyroid nodule was negative for malignant cells, but the marked increase of Ctn level in the FNA wash-out fluid confirmed the diagnostic suspicion of MTC. Since patient refused surgery due to high anesthesiological risk, percutaneous US-guided RFA in single session was performed. At 6-months follow-up the serum Ctn level decreased from the initial value of 647 pg/mL, reaching near-normal range (15 pg/mL), and neck ultrasound showed a complete necrosis of the tumour. Afterward, serum Ctn slowly increased to 49 pg/mL at 15-month follow-up. The US performed at 6 and 12 months of follow-up revealed fibrotic tissue in place of the thyroid nodule, without evidence of cervical lymph-node metastases.

Conclusions

This clinical case suggests that RFA may be effective and safe for treatment of MTC when surgery cannot be performed.

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, 20089, Rozzano, MI, Italy

    Emilia Biamonte, Luigi Solbiati, Gherardo Mazziotti & Andrea Lania

  2. Endocrine, Diabetes and Andrology Unit, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy

    Emilia Biamonte, Paolo Colombo, Elisabetta Lavezzi, Gherardo Mazziotti & Andrea Lania

  3. Department of Radiology, Humanitas Clinical and Research Center, 20089, Rozzano, MI, Italy

    Luigi Solbiati & Tiziana Ierace

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  1. Emilia Biamonte
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  2. Luigi Solbiati
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Correspondence to Gherardo Mazziotti.

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All procedures performed in this study involving a human participant were in accordance with the ethical standards of the Humanitas Ethical Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Biamonte, E., Solbiati, L., Ierace, T. et al. Medullary thyroid carcinoma treated with percutaneous ultrasound-guided radiofrequency ablation. Endocrine 65, 515–519 (2019). https://doi.org/10.1007/s12020-019-01995-w

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